Provider Demographics
NPI:1255333852
Name:NOLAN, JERILYN A (MA OTRL CHT)
Entity Type:Individual
Prefix:
First Name:JERILYN
Middle Name:A
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MA OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6007
Mailing Address - Country:US
Mailing Address - Phone:203-792-5558
Mailing Address - Fax:203-731-3213
Practice Address - Street 1:33 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6007
Practice Address - Country:US
Practice Address - Phone:203-792-5558
Practice Address - Fax:203-731-3213
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000987225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC000267Medicare PIN
CT0198860001Medicare NSC
CT670000100Medicare PIN