Provider Demographics
NPI:1114357159
Name:CROUTHAMEL, NADINE (COTA)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:CROUTHAMEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2798 WHITNEY AVENUE
Mailing Address - Street 2:WHITNEY MANOR CONVALESCENT CENTER
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2798 WHITNEY AVENUE
Practice Address - Street 2:WHITNEY MANOR CONVALESCENT CENTER
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518
Practice Address - Country:US
Practice Address - Phone:203-287-8700
Practice Address - Fax:203-287-7905
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1309224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant