Provider Demographics
NPI:1922019140
Name:CORTELLINO, CHRISTIE
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:
Last Name:CORTELLINO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:CORTELLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1003
Mailing Address - Country:US
Mailing Address - Phone:860-426-9872
Mailing Address - Fax:
Practice Address - Street 1:22 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1417
Practice Address - Country:US
Practice Address - Phone:203-419-0381
Practice Address - Fax:203-419-0389
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002895225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist