Healthcare Provider Details

I. General information

NPI: 1609517077
Provider Name (Legal Business Name): KATHERINE CULLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BOKUM RD
ESSEX CT
06426-1510
US

IV. Provider business mailing address

32 HIGHLAND TER
IVORYTON CT
06442-1135
US

V. Phone/Fax

Practice location:
  • Phone: 860-767-7201
  • Fax:
Mailing address:
  • Phone: 860-304-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5860
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: