Individual
MS. BLAIR RENEE CHURCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
14 2ND ST, STAMFORD, CT 06905-5151
(203) 883-1510
Mailing address
415 PEQUOT AVE, NEW LONDON, CT 06320-4407
(860) 608-5498
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5492
CT
Other
Enumeration date
08/26/2020
Last updated
08/26/2020
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