Provider Demographics
NPI:1063055564
Name:ROMAIN, KATILYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KATILYN
Middle Name:
Last Name:ROMAIN
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 1:84 MARINO DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6709
Mailing Address - Country:US
Mailing Address - Phone:304-641-6665
Mailing Address - Fax:
Practice Address - Street 1:100 BEARD SAWMILL RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6150
Practice Address - Country:US
Practice Address - Phone:304-641-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2076225X00000X
CT5315225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2076OtherOCCUPATIONAL THERAPIST LICENSE
CT5315OtherOCCUPATIONAL THERAPIST LICENSE