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Individual

MR. JERAMIE JASON MOTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
55 CHARTER OAK DR, CHESHIRE, CT 06410-1050
(203) 996-2558
Mailing address
672 QUEEN ST, SOUTHINGTON, CT 06489-1540
(203) 996-2558

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
209109538
CT

Other

Enumeration date
09/27/2023
Last updated
09/27/2023
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