Basic Information
| Provider Information | |||||||||
| NPI: | 1902911019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FILLION | ||||||||
| FirstName: | PEGGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84 UNDERHILL RD | ||||||||
| Address2: | |||||||||
| City: | SANDY HOOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064821207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034265505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 888 WHITE PLAINS RD | ||||||||
| Address2: | |||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066114552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034591133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 002819 | 01 | CT | LICENSE # | OTHER |