Provider Demographics
NPI:1043597388
Name:DUTKO, CHRISTY MARIE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:MARIE
Last Name:DUTKO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1850
Mailing Address - Country:US
Mailing Address - Phone:203-910-7940
Mailing Address - Fax:
Practice Address - Street 1:1 RESERVOIR OFFICE PARK STE 104
Practice Address - Street 2:1449 OLD WATERBURY ROAD
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3926
Practice Address - Country:US
Practice Address - Phone:203-262-9909
Practice Address - Fax:203-262-9911
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist