Provider Demographics
NPI:1134255649
Name:SKONIECKI, MARTA TERESA (MS, ATC)
Entity type:Individual
Prefix:MS
First Name:MARTA
Middle Name:TERESA
Last Name:SKONIECKI
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROUNDTREE DR
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-2735
Mailing Address - Country:US
Mailing Address - Phone:203-507-9614
Mailing Address - Fax:
Practice Address - Street 1:1 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2735
Practice Address - Country:US
Practice Address - Phone:203-507-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer