Individual
RYAN ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(631) 875-8326
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4131
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
002238
CT
Other
Enumeration date
03/01/2023
Last updated
03/01/2023
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