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General NPI Number Information
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NPI Number | 1013300847
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Entity Type | Individual
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Provider Name | KATHERINE BOTASH ST CYR
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Gender | Female
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 98 OAK ST
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City | BINGHAMTON
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State | NY
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Zip | 13905-3769
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Country | US
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Telephone | 607-762-8136
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Fax |
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Provider Business Mailing Address
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Address Line | 4557 SPRUCE RIDGE DR
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City | MANLIUS
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State | NY
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Zip | 13104-9655
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Country | US
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Telephone | 315-727-0088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | NY
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