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NPI Code Detail

MEDICARE: PROF. DARLEEN SANTORE BUSH OTRL

MEDICARE: PROF. DARLEEN SANTORE BUSH OTRL
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
1225X00000XOccupational Therapist001985CT

General Provider Information

NPI Number : 1992827562
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. DARLEEN SANTORE BUSH OTRL
Provider Business Mailing Address
First Line : 15 EDWARD RD
Second Line :
City : NORTH BRANFORD
State : CT
Zip : 06471-1111
Country : US
Telephone Number : 203-484-9469
Fax Number : 860-343-8775
Provider Business Practice Location Address
First Line : 245 LONG HILL RD
Second Line :
City : MIDDLETOWN
State : CT
Zip : 06457-4063
Country : US
Telephone Number : 860-343-8778
Fax Number : 860-343-8775
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/08/2007

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