Individual
TAMEKA TIANA RUDDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
186 WINDBROOK DR, WINDSOR, CT 06095-3563
(860) 992-7504
Mailing address
186 WINDBROOK DR, WINDSOR, CT 06095-3563
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EHH0970594248
—
CT
Enumeration date
12/19/2018
Last updated
12/19/2018
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