Provider Demographics
NPI:1508441379
Name:VOLLARO, KRISTEN CLARK (MS, PTA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CLARK
Last Name:VOLLARO
Suffix:
Gender:F
Credentials:MS, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:IVORYTON
Mailing Address - State:CT
Mailing Address - Zip Code:06442-1254
Mailing Address - Country:US
Mailing Address - Phone:860-227-3263
Mailing Address - Fax:
Practice Address - Street 1:15 WESTWOOD RD
Practice Address - Street 2:
Practice Address - City:IVORYTON
Practice Address - State:CT
Practice Address - Zip Code:06442-1254
Practice Address - Country:US
Practice Address - Phone:860-227-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist