Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 025509 | NY |
NPI | 1003582701 |
---|---|
Provider Name | Miss Andrea Catherine Kelly |
First Address | Watervliet, NY 12189-1121 |
Second Address | Saratoga Springs, NY 12866-1090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2021 |
Last Update Date | 22/08/2021 |