Provider Demographics
NPI:1538512652
Name:GUGINO, TIMOTHY (COTA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:GUGINO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WENDOVER RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1323
Mailing Address - Country:US
Mailing Address - Phone:203-241-4074
Mailing Address - Fax:
Practice Address - Street 1:493 HERITAGE RD
Practice Address - Street 2:SUITE1C
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3879
Practice Address - Country:US
Practice Address - Phone:631-278-0665
Practice Address - Fax:631-619-6680
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001203224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant