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General NPI Number Information
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NPI Number | 1518148733
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Entity Type | Organization
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Legal Business Name | MOZAIC KIDS, LLC
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 13 DEREK RD
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City | STORRS MANSFIELD
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State | CT
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Zip | 06268-2764
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Country | US
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Telephone | 860-456-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 13 DEREK RD
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City | STORRS MANSFIELD
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State | CT
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Zip | 06268-2764
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TIRZA RODA
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Credential |
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Telephone | 860-456-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 000839
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License Number State | CT
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