Provider Demographics
NPI:1407225873
Name:SYNNOTT, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SYNNOTT
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 1:14 OTIS DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1504
Mailing Address - Country:US
Mailing Address - Phone:203-232-9389
Mailing Address - Fax:
Practice Address - Street 1:25 DEPOT HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTHBUTY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-267-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist