=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851225692
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE JOY KEIDERLING COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2026
-----------------------------------------------------
Last Update Date | 06/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 WOODCREST DR
-----------------------------------------------------
City | RIFTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12471-7200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-668-0937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 WOODCREST DR
-----------------------------------------------------
City | RIFTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12471-7200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-668-0937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 011712-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------