Provider Demographics
NPI:1427075274
Name:KESSLER, DONNA (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:KESSLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4105
Mailing Address - Country:US
Mailing Address - Phone:860-646-0188
Mailing Address - Fax:
Practice Address - Street 1:36 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4105
Practice Address - Country:US
Practice Address - Phone:860-646-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002057174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7601OtherMD PHS
CT080002057CT01OtherBLUE SHIELD
50051-AOtherAETNA
A406027OtherOXFORD HEALTH
OR3173OtherHEALTHNET
55000036OtherCIGNA
0995439OtherAETNA - USHC
43401OtherORTHO NET