Healthcare Provider Details

I. General information

NPI: 1528841269
Provider Name (Legal Business Name): KADE COLLINS OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST PATRICK PL
PORT HENRY NY
12974-1200
US

IV. Provider business mailing address

10 ST PATRICK PL
PORT HENRY NY
12974-1200
US

V. Phone/Fax

Practice location:
  • Phone: 518-546-7151
  • Fax: 518-546-3785
Mailing address:
  • Phone: 518-546-7151
  • Fax: 518-546-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number028251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: