Provider Demographics
NPI:1033497201
Name:KREFETZ, JOANN
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:KREFETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 WEMPLE LN
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2423
Mailing Address - Country:US
Mailing Address - Phone:518-393-7911
Mailing Address - Fax:
Practice Address - Street 1:5 CHELSEA PL
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3200
Practice Address - Country:US
Practice Address - Phone:518-881-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000893-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist