Individual
KELLY A MASSUCCI
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.ED. OTR/L
Contact information
Practice address
270 FARMINGTON AVE, SUITE 126, FARMINGTON, CT 06032-1909
(860) 674-1824
Mailing address
111 FOXCROFT RD, WEST HARTFORD, CT 06119-1018
(860) 523-8677
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
002268
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00424493500
—
CT
01
—
3623042
AETNA
CT
Enumeration date
03/21/2006
Last updated
07/09/2007
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