Provider Demographics
NPI:1720385727
Name:CHANNELL, VICTORIA (OTR)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CHANNELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:SPIELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:761 MAIN AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1080
Mailing Address - Country:US
Mailing Address - Phone:203-845-2200
Mailing Address - Fax:
Practice Address - Street 1:761 MAIN AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-845-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3966225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400080295Medicare PIN
CTC00521Medicare PIN