Provider Demographics
NPI:1326520297
Name:PITNEY, STEPHANIE KING
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KING
Last Name:PITNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WYNDING HILLS RD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9631
Mailing Address - Country:US
Mailing Address - Phone:860-380-7781
Mailing Address - Fax:
Practice Address - Street 1:75 GREAT POND RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1980
Practice Address - Country:US
Practice Address - Phone:860-658-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1180224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant