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General NPI Number Information
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NPI Number | 1922479369
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Entity Type | Organization
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Legal Business Name | WELLNESS LOCKER, LLC
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 27 QUINEBAUG AVE
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City | PUTNAM
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State | CT
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Zip | 06260-1943
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Country | US
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Telephone | 860-481-2950
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Fax | 860-955-2740
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Provider Business Mailing Address
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Address Line | 27 QUINEBAUG AVE
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City | PUTNAM
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State | CT
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Zip | 06260-1943
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Country | US
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Telephone | 860-481-2950
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Fax | 860-955-2740
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Authorized Official
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Title or Position | OWNER
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Name | OLIVIA SHEA LOCKER
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Credential | MD
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Telephone | 860-481-2950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 53961
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License Number State | CT
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