Provider Demographics
NPI:1194238659
Name:MOULTON, CATHERINE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MOULTON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06793-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06793-1200
Practice Address - Country:US
Practice Address - Phone:860-350-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer