Healthcare Provider Details

I. General information

NPI: 1265607451
Provider Name (Legal Business Name): TAMARA KOWAL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 3RD ST
STAMFORD CT
06905-4722
US

IV. Provider business mailing address

76 SCARLET OAK DR
WILTON CT
06897-1013
US

V. Phone/Fax

Practice location:
  • Phone: 203-327-4551
  • Fax:
Mailing address:
  • Phone: 773-209-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5245
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: