Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4303 | CT |
NPI | 1386042364 |
---|---|
Provider Name | Kathryn Guedes |
First Address | Shelton, CT 06484-5238 |
Second Address | Bridgeport, CT 06610-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2014 |
Last Update Date | 08/12/2014 |