Individual
KATHLEEN COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1 RANDALL SQ STE 302, PROVIDENCE, RI 02904-2773
(401) 793-1829
Mailing address
903 PROVIDENCE PL APT 146, PROVIDENCE, RI 02903-7003
(203) 848-0175
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT01855
RI
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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