Healthcare Provider Details

I. General information

NPI: 1821370677
Provider Name (Legal Business Name): BRENDA JEAN KOCHANOWSKI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SCHOOL ST
SHERBURNE NY
13460-9505
US

IV. Provider business mailing address

15 SCHOOL ST
SHERBURNE NY
13460-9505
US

V. Phone/Fax

Practice location:
  • Phone: 607-674-7336
  • Fax:
Mailing address:
  • Phone: 607-674-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number004584-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: