Healthcare Provider Details

I. General information

NPI: 1174460646
Provider Name (Legal Business Name): KELLY MORISSETTE ALBERT MS OTR/L
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MAIN ST
ESPERANCE NY
12066-3219
US

IV. Provider business mailing address

121 MAIN ST
ESPERANCE NY
12066-3219
US

V. Phone/Fax

Practice location:
  • Phone: 518-595-9533
  • Fax:
Mailing address:
  • Phone: 518-595-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLY KELLY MORISSETTE ALBERT
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS OTR/L
Phone: 518-585-5955