Provider Demographics
NPI:1639753031
Name:BEDOCS, JUSTINE CAROL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:CAROL
Last Name:BEDOCS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:JUSTINE
Other - Middle Name:CAROL
Other - Last Name:BEDOCS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PREFONTAINE
Mailing Address - Street 1:943 POST ROAD EAST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-341-0178
Mailing Address - Fax:
Practice Address - Street 1:943 POST ROAD EAST
Practice Address - Street 2:SUITE A
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-341-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0024962081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Single Specialty