Provider Demographics
NPI:1598040024
Name:WHEELER, BRIAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WHEELER
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 EAGLE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4696
Mailing Address - Country:US
Mailing Address - Phone:203-706-0135
Mailing Address - Fax:
Practice Address - Street 1:45 MALTBY ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3328
Practice Address - Country:US
Practice Address - Phone:203-924-6174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant