Healthcare Provider Details

I. General information

NPI: 1841683232
Provider Name (Legal Business Name): CAROLYN C. CLYNES MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 THOUSAND ACRES RD
DELANSON NY
12053-1917
US

IV. Provider business mailing address

197 PAWLING AVE
TROY NY
12180-4852
US

V. Phone/Fax

Practice location:
  • Phone: 518-875-6141
  • Fax:
Mailing address:
  • Phone: 518-744-8413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number019517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: