Healthcare Provider Details

I. General information

NPI: 1487643987
Provider Name (Legal Business Name): KATHLEEN GORMLEY OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date: 04/19/2016
Reactivation Date: 01/19/2021

III. Provider practice location address

33 CHURCH HILL RD
NEWTOWN CT
06470-1637
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 475-828-0932
  • Fax: 475-209-8054
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number001906
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number001906
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: