Healthcare Provider Details

I. General information

NPI: 1609113471
Provider Name (Legal Business Name): LINDA PANTANO HASSETT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2013
Last Update Date: 01/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 MAIN ST
PORTLAND CT
06480-1156
US

IV. Provider business mailing address

595 MAIN ST
PORTLAND CT
06480-1156
US

V. Phone/Fax

Practice location:
  • Phone: 860-759-2011
  • Fax: 860-342-4104
Mailing address:
  • Phone: 860-759-2011
  • Fax: 860-342-4104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number001553
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: