Individual
TIERRA PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
189 ALPS RD, BRANFORD, CT 06405-4771
(203) 315-2615
Mailing address
189 ALPS RD, BRANFORD, CT 06405-4771
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2129
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2129
CT LICENSE
CT
Enumeration date
08/13/2021
Last updated
08/13/2021
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