Provider Demographics
NPI:1467004085
Name:DIPASQUALE, KRISTINE MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARIE
Last Name:DIPASQUALE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LABBY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GROSVENORDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06255-1247
Mailing Address - Country:US
Mailing Address - Phone:607-643-2178
Mailing Address - Fax:860-497-0047
Practice Address - Street 1:113 LABBY RD
Practice Address - Street 2:
Practice Address - City:NORTH GROSVENORDALE
Practice Address - State:CT
Practice Address - Zip Code:06255-1247
Practice Address - Country:US
Practice Address - Phone:607-643-2178
Practice Address - Fax:860-497-0047
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1980224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant