Provider Demographics
NPI:1033893391
Name:INGLIS, NATHANIEL REEVE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:REEVE
Last Name:INGLIS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-4039
Mailing Address - Country:US
Mailing Address - Phone:860-953-1201
Mailing Address - Fax:
Practice Address - Street 1:705 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-4039
Practice Address - Country:US
Practice Address - Phone:860-953-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist