Provider Demographics
NPI:1609283381
Name:CREC-CHILDREN'S THERAPY SPECIALIST
Entity Type:Organization
Organization Name:CREC-CHILDREN'S THERAPY SPECIALIST
Other - Org Name:CHILDREN'S THERAPY SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-289-9079
Mailing Address - Street 1:111 CHARTER OAK AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1912
Mailing Address - Country:US
Mailing Address - Phone:860-298-9079
Mailing Address - Fax:860-683-2398
Practice Address - Street 1:601 RIVER ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1325
Practice Address - Country:US
Practice Address - Phone:860-298-9079
Practice Address - Fax:860-683-2398
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL REGION EDUCATION COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT790075OtherCONNECTICARE
CT0401135OtherAETNA
CT0401137OtherCIGNA