Individual
STEPHANIE BIRCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, EMT-B
Contact information
Practice address
437 PEQUOT AVE, NEW LONDON, CT 06320-4498
(860) 701-3518
Mailing address
437 PEQUOT AVE, NEW LONDON, CT 06320-4498
(860) 701-3518
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
007199
CT
2255A2300X
Athletic Trainer
Primary
000411
CT
Other
Enumeration date
06/23/2022
Last updated
06/23/2022
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