Provider Demographics
NPI:1023476108
Name:MCVETY-BAUCO, DEIDRE (MSOTR)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:MCVETY-BAUCO
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 HIGHLAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2549
Mailing Address - Country:US
Mailing Address - Phone:203-699-9264
Mailing Address - Fax:203-699-6141
Practice Address - Street 1:335 HIGHLAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2549
Practice Address - Country:US
Practice Address - Phone:203-699-9264
Practice Address - Fax:203-699-6141
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0018545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist