Healthcare Provider Details

I. General information

NPI: 1073676177
Provider Name (Legal Business Name): CENTER FOR PEDIATRIC THERAPY-FAIRFIELD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 POST RD SUITE 204
FAIRFIELD CT
06824-6038
US

IV. Provider business mailing address

203 BROAD ST UNIT C-2
MILFORD CT
06460-4751
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-3669
  • Fax: 205-255-1173
Mailing address:
  • Phone: 203-876-2000
  • Fax: 203-876-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE KINSELLA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 203-876-2000