Individual
KESHAP GAUTAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
45 MERIDEN AVE, SOUTHINGTON, CT 06489-3214
(860) 453-4170
Mailing address
45 MERIDEN AVE, SOUTHINGTON, CT 06489-3214
(949) 371-4733
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
001413
CT
224Z00000X
Occupational Therapy Assistant
2638
CA
Other
Enumeration date
04/16/2014
Last updated
10/16/2014
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