Healthcare Provider Details

I. General information

NPI: 1194635508
Provider Name (Legal Business Name): CASSIDY GIROLAMO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HUNTLEY ROAD
OLY LYME CT
06371
US

IV. Provider business mailing address

4 HUNTLEY ROAD
OLY LYME CT
06371
US

V. Phone/Fax

Practice location:
  • Phone: 860-434-5524
  • Fax: 860-434-3262
Mailing address:
  • Phone: 860-434-5524
  • Fax: 860-434-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6959
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: