1891949434 NPI number — MRS. KELLY PATRICE HOCHSTETLER MOT, OTR, CLT

Table of content: MRS. KELLY PATRICE HOCHSTETLER MOT, OTR, CLT (NPI 1891949434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891949434 NPI number — MRS. KELLY PATRICE HOCHSTETLER MOT, OTR, CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOCHSTETLER
Provider First Name:
KELLY
Provider Middle Name:
PATRICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MOT, OTR, CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891949434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 BENNETTS BRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY HOOK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06482-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-659-6929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 OLD WATERBURY RD., SUITE 101
Provider Second Line Business Practice Location Address:
PHYS. MED. CTR. OF SOUTHBURY
Provider Business Practice Location Address City Name:
SOUTHBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-262-4230
Provider Business Practice Location Address Fax Number:
203-262-4239
Provider Enumeration Date:
11/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0019X , with the licence number:  003131 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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