MEDICARE: MRS. KATHY F. STELIK OTRL

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
1	225X00000X	Occupational Therapist	000079	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	130000079CT03	OTHER	CT	BCBS ID NUMBER
2	29195-6	OTHER	RI	BCBS RI NUMBER
3	2V7212	OTHER	CT	HEALTHNET ID NUMBER

General Provider Information

NPI Number	:	1780788208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHY F. STELIK OTRL

Provider Business Mailing Address
First Line	:	88 NORWICH NEW LONDON TPKE
Second Line	:	SUITE 1
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-2518
Country	:	US
Telephone Number	:	860-848-9157
Fax Number	:	860-848-3471

Provider Business Practice Location Address
First Line	:	88 NORWICH NEW LONDON TPKE
Second Line	:	SUITE 1
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-2518
Country	:	US
Telephone Number	:	860-848-9157
Fax Number	:	860-848-3471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	06/23/2011

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