Provider Demographics
NPI:1720302995
Name:RAFFERTY, SHIRLEY ANN (BS)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOGEE RD
Mailing Address - Street 2:PO BOX 351
Mailing Address - City:THOMPSON
Mailing Address - State:CT
Mailing Address - Zip Code:06277-2509
Mailing Address - Country:US
Mailing Address - Phone:508-579-4350
Mailing Address - Fax:
Practice Address - Street 1:6 LOGEE RD
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:CT
Practice Address - Zip Code:06277-2509
Practice Address - Country:US
Practice Address - Phone:508-579-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001146225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology