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NPI Code Detail

MEDICARE: KELLY LYNN CASTOR DTA

MEDICARE: KELLY LYNN CASTOR DTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental TherapistCT
2222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1396925897
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY LYNN CASTOR DTA
Provider Business Mailing Address
First Line : 242 MAIN ST
Second Line :
City : EAST WINDSOR
State : CT
Zip : 06088-9519
Country : US
Telephone Number : 860-670-1383
Fax Number :
Provider Business Practice Location Address
First Line : 110 COURT ST STE 3
Second Line :
City : CROMWELL
State : CT
Zip : 06416-1273
Country : US
Telephone Number : 860-613-9930
Fax Number : 860-613-9952
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2007
Last Update Date : 06/23/2025

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Directions to “ KELLY LYNN CASTOR DTA” Practice Location

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