Provider Demographics
NPI:1568289742
Name:MILORD, LIGI-ELIN JACOB (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:LIGI-ELIN
Middle Name:JACOB
Last Name:MILORD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:LIGI-ELIN
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAT
Mailing Address - Street 1:134 NORTON LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2238
Mailing Address - Country:US
Mailing Address - Phone:860-338-1267
Mailing Address - Fax:
Practice Address - Street 1:915 SULLIVAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2165
Practice Address - Country:US
Practice Address - Phone:860-644-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist