Healthcare Provider Details

I. General information

NPI: 1124163605
Provider Name (Legal Business Name): KIMBERLY HAJJAR OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N PLAINS INDUSTRIAL RD BUILDING 2
WALLINGFORD CT
06492-2360
US

IV. Provider business mailing address

1300 POST RD STE 204
FAIRFIELD CT
06824-6038
US

V. Phone/Fax

Practice location:
  • Phone: 203-949-9337
  • Fax:
Mailing address:
  • Phone: 203-255-3669
  • Fax: 203-255-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number001344
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: