Provider Demographics
NPI:1184073660
Name:KWESKIN, KATHLEEN JARAMILLO (LMT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JARAMILLO
Last Name:KWESKIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PADANARAM RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-2812
Mailing Address - Country:US
Mailing Address - Phone:203-417-9969
Mailing Address - Fax:
Practice Address - Street 1:901 ETHAN ALLEN HWY STE 109
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-2838
Practice Address - Country:US
Practice Address - Phone:203-403-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60656894225700000X
CT9659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist