Provider Demographics
NPI:1770700932
Name:ATKINS, MARY FAITH (COTA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:FAITH
Last Name:ATKINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 TUNXIS AVE
Mailing Address - Street 2:P.O. BOX 216
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1124
Mailing Address - Country:US
Mailing Address - Phone:860-243-5386
Mailing Address - Fax:
Practice Address - Street 1:29 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1324
Practice Address - Country:US
Practice Address - Phone:860-236-5623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000894224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant