Healthcare Provider Details

I. General information

NPI: 1831804285
Provider Name (Legal Business Name): OLIVIA KODSY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ROBINSON RD
CLINTON NY
13323-1418
US

IV. Provider business mailing address

19 ROBINSON RD
CLINTON NY
13323-1418
US

V. Phone/Fax

Practice location:
  • Phone: 315-853-6090
  • Fax:
Mailing address:
  • Phone: 315-853-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number027328-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: