Provider Demographics
NPI:1497312847
Name:GLYNN, KATHLEEN A (OT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:GLYNN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-0993
Mailing Address - Country:US
Mailing Address - Phone:203-815-5767
Mailing Address - Fax:
Practice Address - Street 1:16 HOPSON AVE
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3631
Practice Address - Country:US
Practice Address - Phone:203-815-5767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2848225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist