Individual
KELLI LAVOIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
10 THURBER RD, PUTNAM, CT 06260-2518
(860) 928-3539
Mailing address
144 UNDERWOOD RD, PUTNAM, CT 06260-1864
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
000313
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000313
PTA LICENSE
CT
Enumeration date
04/03/2007
Last updated
07/08/2007
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