Provider Demographics
NPI:1023376639
Name:SHEMO, KARA NICOLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:NICOLE
Last Name:SHEMO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BUCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1204
Mailing Address - Country:US
Mailing Address - Phone:860-608-9827
Mailing Address - Fax:
Practice Address - Street 1:23 BUCKLAND RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1204
Practice Address - Country:US
Practice Address - Phone:860-608-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001264224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant