Healthcare Provider Details

I. General information

NPI: 1699396564
Provider Name (Legal Business Name): KATHLEEN CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 05/02/2020
Certification Date: 05/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 TODDY HILL RD
SANDY HOOK CT
06482-1362
US

IV. Provider business mailing address

105 MEADOW ST
MILFORD CT
06461-2620
US

V. Phone/Fax

Practice location:
  • Phone: 203-218-5675
  • Fax:
Mailing address:
  • Phone: 203-218-5675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number001416
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: