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General NPI Number Information
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NPI Number | 1336560994
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Entity Type | Individual
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Provider Name | KAITLYN KAUDER
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Gender | Female
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Dates
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Enumeration Date | 12/30/2013
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 252 BREHAUT AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10307-1308
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Country | US
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Telephone | 646-610-9104
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Fax |
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Provider Business Mailing Address
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Address Line | 52 PROL PLACE
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City | STATEN ISLAND
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State | NY
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Zip | 10312
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Country | US
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Telephone | 646-610-9104
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 018446-1
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License Number State | NY
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