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Individual

BRENNA NATALIA DESTEFANO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSOT, OTR/L

Contact information

Practice address
396 DANBURY RD STE 2A, WILTON, CT 06897-2024
(203) 422-2193
Mailing address
333 VINCELLETTE ST UNIT 103, BRIDGEPORT, CT 06606-2267
(570) 640-4194

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
024161
NY
225X00000X
Occupational Therapist
Primary
5274
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
024161
NY STATE EDUCATION DEPARTMENT OFFICE OF PROFESSION
NY
01
5274
CONNECTICUT DEPARTMENT OF PUBLIC HEALTH
CT
Enumeration date
11/25/2019
Last updated
11/25/2019
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