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NPI Code Detail

MEDICARE: KERBY COULANGES O.T.

MEDICARE: KERBY COULANGES O.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist031509-1NY

General Provider Information

NPI Number : 1457399529
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERBY COULANGES O.T.
Provider Business Mailing Address
First Line : 4123 CLARENDON RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-5136
Country : US
Telephone Number : 718-629-0940
Fax Number : 631-467-0928
Provider Business Practice Location Address
First Line : 20 PEACHTREE CT
Second Line : #105
City : HOLBROOK
State : NY
Zip : 11741-4616
Country : US
Telephone Number : 631-467-3700
Fax Number : 631-467-0928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 07/08/2007

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