MEDICARE: BRENDA HULTGREN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	002199	CT

General Provider Information

NPI Number	:	1447539473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA HULTGREN OTR/L

Provider Business Mailing Address
First Line	:	16 AIMEE DR
Second Line	:
City	:	PAWCATUCK
State	:	CT
Zip	:	06379-2429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 DROZDYK DR
Second Line	:
City	:	GROTON
State	:	CT
Zip	:	06340-4248
Country	:	US
Telephone Number	:	860-446-2889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	08/09/2011

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