Organization
DYNAMIC CHILD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REGAN HILLEBRECHT WALTERS COTA/L (OWNER)
(860) 310-8676
Entity
Organization
Contact information
Practice address
175 HARTFORD TURNPIKE, TOLLAND, CT 06084
(860) 310-8676
Mailing address
64 LAMB RD, STAFFORD SPRINGS, CT 06076-3313
(860) 310-8676
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114431038
—
CT
05
—
1134593247
—
CT
05
—
1225363070
—
CT
Enumeration date
02/16/2022
Last updated
02/16/2022
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