Healthcare Provider Details

I. General information

NPI: 1154851285
Provider Name (Legal Business Name): CATHERINE GAVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 CALEB AVE
SYRACUSE NY
13206-2560
US

IV. Provider business mailing address

5004 HALLINAN DR
SYRACUSE NY
13215-2504
US

V. Phone/Fax

Practice location:
  • Phone: 315-218-7444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberP06222
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: