Provider Demographics
NPI:1003201070
Name:KACZOR, KATHRYN ALEXANDRA MOTSKO (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALEXANDRA MOTSKO
Last Name:KACZOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ALEXANDRA
Other - Last Name:MOTSKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:123 N ARCH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1427
Mailing Address - Country:US
Mailing Address - Phone:607-239-1817
Mailing Address - Fax:
Practice Address - Street 1:1695 ALLEN GLEN RD
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-3433
Practice Address - Country:US
Practice Address - Phone:607-725-7420
Practice Address - Fax:607-687-4249
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006858225X00000X
CA17027225X00000X
NY023676-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist