Provider Demographics
NPI:1093523912
Name:ROAD TO INDEPENDENCE
Entity type:Organization
Organization Name:ROAD TO INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COALSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, MED, CBT
Authorized Official - Phone:203-376-6640
Mailing Address - Street 1:92 KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9540
Mailing Address - Country:US
Mailing Address - Phone:203-376-6640
Mailing Address - Fax:
Practice Address - Street 1:769 NEWFIELD ST STE 4
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1846
Practice Address - Country:US
Practice Address - Phone:203-376-6640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYNN COALSON, OTR/L, M.ED., CBT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty