Healthcare Provider Details

I. General information

NPI: 1902614894
Provider Name (Legal Business Name): KIMBERLY SCHOR OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LAKEWOOD RD
WATERBURY CT
06704-5400
US

IV. Provider business mailing address

22 TOMPKINS ST
WATERBURY CT
06708-1458
US

V. Phone/Fax

Practice location:
  • Phone: 203-759-1122
  • Fax: 203-596-9882
Mailing address:
  • Phone: 203-419-0381
  • Fax: 203-419-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6570
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: