Provider Demographics
NPI:1023156759
Name:NORMAND, MIRKA (OTR, MA, CHT, COMT)
Entity type:Individual
Prefix:MRS
First Name:MIRKA
Middle Name:
Last Name:NORMAND
Suffix:
Gender:F
Credentials:OTR, MA, CHT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HAZELNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3268
Mailing Address - Country:US
Mailing Address - Phone:860-446-8265
Mailing Address - Fax:860-445-2076
Practice Address - Street 1:52 HAZELNUT HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3268
Practice Address - Country:US
Practice Address - Phone:860-446-8265
Practice Address - Fax:860-445-2076
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4617-026225XH1200X, 225X00000X
TX109297225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41064900Medicaid