Healthcare Provider Details

I. General information

NPI: 1447160650
Provider Name (Legal Business Name): KY CONSTANTINO MARCAYDA OTR, OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GATEWAY BLVD N
CHESTERTON IN
46304-9658
US

IV. Provider business mailing address

1230 S COLORADO CT
HOBART IN
46342-5847
US

V. Phone/Fax

Practice location:
  • Phone: 121-992-1144
  • Fax:
Mailing address:
  • Phone: 219-407-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31009135A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: