# OUTPATIENT MOBILE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Outpatient Mobile
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144793316
- **Authorized official:** TANYA LEE CLARK OTD OTR/L (OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (607) 643-2178

## Contact information

- **Practice address:** 113 LABBY RD, NORTH GROSVENORDALE, CT 06255-1247
- **Practice address phone:** (607) 643-2178
- **Mailing address:** 113 LABBY RD, NORTH GROSVENORDALE, CT 06255-1247
- **Mailing address phone:** (607) 643-2178

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2019
- **Last updated:** 01/09/2019