Provider Demographics
NPI:1184931875
Name:PROMOTING PARTICIPATION
Entity type:Organization
Organization Name:PROMOTING PARTICIPATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS SPED/AT, OTR/L
Authorized Official - Phone:860-798-8638
Mailing Address - Street 1:24 NEW HAMPSHIRE DR
Mailing Address - Street 2:UNIT C9
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1170
Mailing Address - Country:US
Mailing Address - Phone:860-798-8638
Mailing Address - Fax:
Practice Address - Street 1:24 NEW HAMPSHIRE DR
Practice Address - Street 2:UNIT C9
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1170
Practice Address - Country:US
Practice Address - Phone:860-798-8638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1093970519OtherINDIVIDUAL NPI