Provider Demographics
NPI:1437593092
Name:REEVES, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:REEVES
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 1:35 PAXTON CT
Mailing Address - Street 2:PO BOX 145
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756-2108
Mailing Address - Country:US
Mailing Address - Phone:860-491-3232
Mailing Address - Fax:
Practice Address - Street 1:35 PAXTON CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:CT
Practice Address - Zip Code:06756-2108
Practice Address - Country:US
Practice Address - Phone:860-491-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001146224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant