Provider Demographics
NPI:1891949434
Name:HOCHSTETLER, KELLY PATRICE (MOT, OTR, CLT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:PATRICE
Last Name:HOCHSTETLER
Suffix:
Gender:F
Credentials:MOT, OTR, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BENNETTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1423
Mailing Address - Country:US
Mailing Address - Phone:414-659-6929
Mailing Address - Fax:
Practice Address - Street 1:22 OLD WATERBURY RD., SUITE 101
Practice Address - Street 2:PHYS. MED. CTR. OF SOUTHBURY
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-262-4230
Practice Address - Fax:203-262-4239
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003131225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03227Medicare PIN