Individual
MISS TARA MARIE KONIECZNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 SEABURY DR, BLOOMFIELD, CT 06002-2650
(860) 286-0243
Mailing address
238 SILVER ST, NORTH GRANBY, CT 06060-1104
(860) 978-7768
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
001739
CT
Other
Enumeration date
01/08/2018
Last updated
01/08/2018
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