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NPI Code Detail

MEDICARE: KRISTY ANN O'BRIEN BARACCO COTA/L

MEDICARE: KRISTY ANN O'BRIEN BARACCO COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant000785CT
2225700000XMassage Therapist004709CT

General Provider Information

NPI Number : 1235371048
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTY ANN O'BRIEN BARACCO COTA/L
Provider Business Mailing Address
First Line : 189 GIFFORD LN
Second Line :
City : BOZRAH
State : CT
Zip : 06334-1318
Country : US
Telephone Number : 860-705-6801
Fax Number :
Provider Business Practice Location Address
First Line : 3 S WIG HILL RD
Second Line :
City : CHESTER
State : CT
Zip : 06412-1106
Country : US
Telephone Number : 860-526-5316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2009
Last Update Date : 03/26/2009

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