Individual
THERESA BORTOLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
(203) 679-5959
Mailing address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1635
CT
Other
Enumeration date
01/18/2016
Last updated
01/18/2016
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