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General NPI Number Information
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NPI Number | 1548701154
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Entity Type | Organization
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Legal Business Name | KERRY COONS
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 481 BRADFORD RD
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City | SCHENECTADY
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State | NY
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Zip | 12304-3721
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Country | US
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Telephone | 518-320-6386
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Fax |
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Provider Business Mailing Address
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Address Line | 481 BRADFORD RD
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City | SCHENECTADY
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State | NY
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Zip | 12304
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Country | US
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Telephone | 518-320-6386
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Fax |
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Authorized Official
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Title or Position | COTA
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Name | KERRY L COONS
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Credential | COTA/L
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Telephone | 518-320-6386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 009065-1
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License Number State | NY
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