Provider Demographics
NPI:1750717419
Name:AZZINARO, JODI
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:AZZINARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BOSTON POST RD STE 3
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2736
Mailing Address - Country:US
Mailing Address - Phone:203-458-1000
Mailing Address - Fax:203-286-1688
Practice Address - Street 1:725 BOSTON POST RD STE 3
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2736
Practice Address - Country:US
Practice Address - Phone:203-458-1000
Practice Address - Fax:203-286-1688
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001384224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant