Provider Demographics
NPI:1821673724
Name:KERRIGAN, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:KERRIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WEST STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06414
Mailing Address - Country:US
Mailing Address - Phone:860-613-9930
Mailing Address - Fax:860-613-9952
Practice Address - Street 1:62 WEST STREET
Practice Address - Street 2:SUITE F
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06414-4405
Practice Address - Country:US
Practice Address - Phone:860-613-9930
Practice Address - Fax:860-613-9952
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist