Individual
RANDY LOUIS CHAMPAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
72 SALMON BROOK DR, GLASTONBURY, CT 06033-2131
(860) 633-5244
Mailing address
10 BRIARWOOD LN, DURHAM, CT 06422-1219
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1418
CT
Other
Enumeration date
09/30/2013
Last updated
09/30/2013
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