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Individual

MS. MICHELLE ANNE BLACKBURN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT/L

Contact information

Practice address
77 S CANAAN RD, CANAAN, CT 06018-2517
(860) 824-2600
Mailing address
22 WINDMILL SPRINGS DRIVE, GRANBY, CT 06035

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
001067
CT
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
001067
CT

Other

Enumeration date
05/22/2017
Last updated
05/22/2017
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