Provider Demographics
NPI:1376831438
Name:VAN DEVEIRE, KATHERINE (DPT, OCS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:VAN DEVEIRE
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 BOLTON RD
Mailing Address - Street 2:UNIT 1249
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-1249
Mailing Address - Country:US
Mailing Address - Phone:860-486-8080
Mailing Address - Fax:
Practice Address - Street 1:843 BOLTON RD
Practice Address - Street 2:UNIT 1249
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-1249
Practice Address - Country:US
Practice Address - Phone:860-486-8080
Practice Address - Fax:860-486-8081
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT009143OtherCT LICENSE