Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 001114 | CT |
N | 225XP0200X | Occupational Therapist - Pediatrics | 001114 | CT |
NPI | 1063991636 |
---|---|
Provider Name | Karen Brazauskas |
First Address | Southbury, CT 06488-1896 |
Second Address | Oakville, CT 06779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 14/08/2018 |