Individual
MISS FAYSULLY GLORIA TRIANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4200 MAIN ST, STRATFORD, CT 06614-3342
(203) 386-0301
Mailing address
4200 MAIN ST, STRATFORD, CT 06614-3342
(203) 386-0301
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
003811
CT
Other
Enumeration date
08/10/2011
Last updated
08/10/2011
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