Individual
MRS. DONNA MAIRE KOOKOOLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
30 BOKUM RD, ESSEX, CT 06426-1510
(860) 767-4578
Mailing address
12 BEECH ST, NORTH BRANFORD, CT 06471-1479
(203) 645-8586
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
000286
CT
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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