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General NPI Number Information
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NPI Number | 1629351515
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Entity Type | Organization
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Legal Business Name | MEDTRAVELERS
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 1138 FOX HILL RD
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City | CHESHIRE
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State | CT
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Zip | 06410-1809
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Country | US
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Telephone | 203-980-0474
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Fax |
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Provider Business Mailing Address
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Address Line | 1138 FOX HILL RD
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City | CHESHIRE
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State | CT
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Zip | 06410-1809
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Country | US
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Telephone | 203-980-0474
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JENNIFER THERESA LENDINO
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Credential | MS OTR/L
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Telephone | 203-980-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OC012007
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License Number State | PA
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