Provider Demographics
NPI:1134497373
Name:WEST, MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BRITTANY FARMS RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1154
Mailing Address - Country:US
Mailing Address - Phone:860-612-6003
Mailing Address - Fax:860-612-6038
Practice Address - Street 1:400 BRITTANY FARMS RD
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-1154
Practice Address - Country:US
Practice Address - Phone:860-612-6003
Practice Address - Fax:860-612-6038
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000882225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1464179OtherTAX ID NUMBER