Individual
REBECCA LEE MYDLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1931 BLACK ROCK TPKE, FAIRFIELD, CT 06825-3506
(203) 384-8681
(203) 384-0722
Mailing address
1931 BLACK ROCK TPKE, ATTN: CREDENTIALING, FAIRFIELD, CT 06825-3506
(203) 384-8681
(203) 384-0722
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
004581
CT
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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