Provider Demographics
NPI:1710364161
Name:WELLS, LINDA (COTA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 LIBERTY ST
Mailing Address - Street 2:#1
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1631
Mailing Address - Country:US
Mailing Address - Phone:860-287-2965
Mailing Address - Fax:
Practice Address - Street 1:57 LIBERTY ST
Practice Address - Street 2:#1
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1631
Practice Address - Country:US
Practice Address - Phone:860-287-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1589224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant