Individual
STACEY GORDON CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL CHT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT00892
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000291880
BCBS OF RI
RI
01
—
001072
BLUE CHIP OF RI
RI
Enumeration date
04/27/2006
Last updated
07/08/2007
Update your record
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