Individual
ISEMITE MILFORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
6448 MAIN ST, TRUMBULL, CT 06611-2075
(203) 268-6204
Mailing address
6448 MAIN ST, TRUMBULL, CT 06611-2075
(203) 268-6204
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
001060
CT
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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