Healthcare Provider Details

I. General information

NPI: 1871854984
Provider Name (Legal Business Name): KATHRYN ALEXANDRA MARCIANO MSED; COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 WESTCHESTER AVENUE SUITE N-230
WHITE PLAINS NY
10604
US

IV. Provider business mailing address

52 ANDRE AVE
TAPPAN NY
10983-2302
US

V. Phone/Fax

Practice location:
  • Phone: 914-576-5292
  • Fax:
Mailing address:
  • Phone: 845-729-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1151695
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number009756-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: