Individual
JORGE L TELLEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA,L
Contact information
Practice address
145 GROVE ST, WATERBURY, CT 06710-2202
(203) 753-7205
Mailing address
48 INDUSTRIAL PARK ACCESS RD, MIDDLEFIELD, CT 06455-1263
(203) 859-1182
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
001138
CT
Other
Enumeration date
10/30/2012
Last updated
10/30/2012
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