Healthcare Provider Details

I. General information

NPI: 1427973015
Provider Name (Legal Business Name): KELLI ANN SCHAEFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N MAIN STREET EXT # 2B
WALLINGFORD CT
06492-2400
US

IV. Provider business mailing address

17 BEECHWOOD DR
DEEP RIVER CT
06417-1524
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15600
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: