Provider Demographics
NPI:1063991636
Name:BRAZAUSKAS, KAREN (OTR/L)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BRAZAUSKAS
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 1:179 DUBLIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1896
Mailing Address - Country:US
Mailing Address - Phone:203-525-5458
Mailing Address - Fax:
Practice Address - Street 1:JUMPSTART THERAPY AND FITNESS NETWORK
Practice Address - Street 2:900 MAIN ST
Practice Address - City:OAKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06779
Practice Address - Country:US
Practice Address - Phone:860-945-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001114225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics