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General NPI Number Information
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NPI Number | 1477792760
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Entity Type | Individual
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Provider Name | KELLY COLE OTR
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Gender | Female
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 12/03/2016
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Provider Practice Location Address
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Address Line | 31 FERNICH CT
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City | MONTGOMERY
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State | NY
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Zip | 12549
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Country | US
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Telephone | 845-597-6634
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Fax |
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Provider Business Mailing Address
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Address Line | 31 FERNICH CT
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City | MONTGOMERY
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State | NY
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Zip | 12549
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Country | US
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Telephone | 845-597-6634
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 006271-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 017608-1
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License Number State | NY
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