Individual
MRS. KISHA K COUNCIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
411 E MAIN ST, BRIDGEPORT, CT 06608-2326
(203) 345-3088
Mailing address
319 CARROLL AVE, BRIDGEPORT, CT 06607-1815
(203) 449-6947
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
048685
CT
Other
Enumeration date
08/21/2012
Last updated
08/21/2012
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