Provider Demographics
NPI:1225157282
Name:MESTEMAKER-HARRIS, CATHERINE JOAN (COTA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JOAN
Last Name:MESTEMAKER-HARRIS
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 1:94 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-2132
Mailing Address - Country:US
Mailing Address - Phone:860-564-4553
Mailing Address - Fax:
Practice Address - Street 1:20 BABCOCK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1226
Practice Address - Country:US
Practice Address - Phone:860-564-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000677314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility