=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194026856
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KESLER CARRIE OTR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2010
-----------------------------------------------------
Last Update Date | 12/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 944 UNIONDALE AVE
-----------------------------------------------------
City | UNIONDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11553-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-644-5971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 944 UNIONDALE AVE
-----------------------------------------------------
City | UNIONDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11553-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-644-5971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 226300000X
-----------------------------------------------------
Taxonomy Name | Kinesiotherapist
-----------------------------------------------------
License Number | 014158
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 014158
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------