Healthcare Provider Details

I. General information

NPI: 1275842353
Provider Name (Legal Business Name): KAITLIN E PARKS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 265
HURLEYVILLE NY
12747-0265
US

IV. Provider business mailing address

PO BOX 265
HURLEYVILLE NY
12747-0265
US

V. Phone/Fax

Practice location:
  • Phone: 845-551-9948
  • Fax:
Mailing address:
  • Phone: 845-551-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number016376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: