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Individual

COLLEEN A GAVNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
515 CENTERPOINT DR, MIDDLETOWN, CT 06457-7570
(860) 421-4052
(860) 421-4053
Mailing address
45 OLD KINGS RD, AVON, CT 06001-2300
(716) 310-1565

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2058
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2058
STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH
CT
Enumeration date
06/01/2020
Last updated
06/01/2020
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