Provider Demographics
NPI:1447971635
Name:BENEDITO, KATHERINE E (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:BENEDITO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1934
Mailing Address - Country:US
Mailing Address - Phone:203-954-5952
Mailing Address - Fax:
Practice Address - Street 1:93 NORTH ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1934
Practice Address - Country:US
Practice Address - Phone:203-954-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT005639OtherOCCUPATIONAL THERAPY LICENSE