Healthcare Provider Details

I. General information

NPI: 1700126323
Provider Name (Legal Business Name): KATHLEEN ELIZABETH RUOPP COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 TODDY HILL RD
SANDY HOOK CT
06482-1362
US

IV. Provider business mailing address

139 TODDY HILL RD.
NEWTOWN CT
06470
US

V. Phone/Fax

Practice location:
  • Phone: 203-364-3125
  • Fax:
Mailing address:
  • Phone: 203-364-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number001168
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: