Healthcare Provider Details

I. General information

NPI: 1558602730
Provider Name (Legal Business Name): KELLY S COHEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WHITESBORO ST FL 1
YORKVILLE NY
13495-1316
US

IV. Provider business mailing address

95 WHITESBORO ST FL 1
YORKVILLE NY
13495-1316
US

V. Phone/Fax

Practice location:
  • Phone: 315-768-3774
  • Fax:
Mailing address:
  • Phone: 315-768-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008364-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: