Jessica Boyden, LMT
Individual provider Active NPI Specialist · Groton, CT
NPI 1306238258 · NPPES record last updated Mar 2, 2015
Key facts
- NPI
- 1306238258
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 004377 (CT)
- Practice address
- 167 Broad St
Groton, CT 06340-3644 - Phone
- (860) 448-6766
- NPI assigned
- Mar 2, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT-17303 | AZ | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 004377 | CT | Yes |
| Specialist | 174400000X | MT-17303 | AZ |
Addresses
Primary practice location
167 Broad St
Groton, CT 06340-3644
Mailing address
13 Pinecrest Rd
North Stonington, CT 06359-1527
Phone (860) 694-9945
Other providers in Groton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.