Provider Demographics
NPI:1710149554
Name:CONNOLLY, CATHLEEN MARIE (OT)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:MARIE
Last Name:CONNOLLY
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 1:220 S DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1759
Mailing Address - Country:US
Mailing Address - Phone:208-265-4514
Mailing Address - Fax:208-263-3789
Practice Address - Street 1:220 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1759
Practice Address - Country:US
Practice Address - Phone:208-265-4514
Practice Address - Fax:208-263-3789
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-863225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist