Provider Demographics
NPI:1417395443
Name:GAENZLER, KATIE LYNN MORAVEC (COTA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN MORAVEC
Last Name:GAENZLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:MORAVEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1098 E MAIN ST
Mailing Address - Street 2:3RD FLOOR, APARTMENT 6
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1077
Mailing Address - Country:US
Mailing Address - Phone:860-919-5069
Mailing Address - Fax:
Practice Address - Street 1:1098 E MAIN ST
Practice Address - Street 2:3RD FLOOR, APARTMENT 6
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1077
Practice Address - Country:US
Practice Address - Phone:860-919-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001197224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant