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Individual

AMANDA BAUM-JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1300 POST RD STE 204, FAIRFIELD, CT 06824-6038
(203) 255-3669
(203) 254-3790
Mailing address
101 N PLAINS INDUSTRIAL RD BLDG 2, WALLINGFORD, CT 06492-2360
(203) 949-9337
(203) 284-3779

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
003837
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
003837
CT LICENSE
CT
Enumeration date
06/26/2012
Last updated
11/28/2021
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