Provider Demographics
NPI:1063083525
Name:ROMERO-GILLESPIE, CARLA (COTA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:ROMERO-GILLESPIE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RAQUEL DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-3205
Mailing Address - Country:US
Mailing Address - Phone:845-443-3223
Mailing Address - Fax:
Practice Address - Street 1:14 RAQUEL DR
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-3205
Practice Address - Country:US
Practice Address - Phone:845-443-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2119224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant