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General NPI Number Information
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NPI Number | 1982746707
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Entity Type | Individual
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Provider Name | KATHLEEN ANNE O'CONNOR PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30 SHELBURNE RD
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City | STAMFORD
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State | CT
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Zip | 06902-3628
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Country | US
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Telephone | 203-276-2330
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Fax | 203-276-2299
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Provider Business Mailing Address
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Address Line | 8 BOBBIE LN
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City | RYE BROOK
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State | NY
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Zip | 10573-1206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 000993
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License Number State | CT
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