Healthcare Provider Details

I. General information

NPI: 1740421619
Provider Name (Legal Business Name): MARY CATHERINE SHEEHAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 TOMPKINS ST
WATERBURY CT
06708-1459
US

IV. Provider business mailing address

88 BEAR RUN
WOODBURY CT
06798-3334
US

V. Phone/Fax

Practice location:
  • Phone: 203-419-0381
  • Fax: 203-419-0389
Mailing address:
  • Phone: 203-263-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number001338
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: