Provider Demographics
NPI:1952569782
Name:BRUNO, JAIME LEIGH (MOTR L)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LEIGH
Last Name:BRUNO
Suffix:
Gender:F
Credentials:MOTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 TOWN COLONY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5937
Mailing Address - Country:US
Mailing Address - Phone:860-788-2984
Mailing Address - Fax:
Practice Address - Street 1:565 VERNON STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-788-2984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003340225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist