Provider Demographics
NPI:1386655280
Name:SESESKE, KRISTEN APRIL (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:APRIL
Last Name:SESESKE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:APRIL
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21 ROSE CRICLE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450
Mailing Address - Country:US
Mailing Address - Phone:203-440-3732
Mailing Address - Fax:
Practice Address - Street 1:60 WESTWOOD AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-597-1609
Practice Address - Fax:203-597-1581
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3970622OtherAETNA
130002769CT02OtherBCBS
C01826Medicare ID - Type Unspecified