Provider Demographics
NPI:1043596240
Name:ETS, KAILI (BHSC, MSCOT)
Entity Type:Individual
Prefix:MRS
First Name:KAILI
Middle Name:
Last Name:ETS
Suffix:
Gender:F
Credentials:BHSC, MSCOT
Other - Prefix:MS
Other - First Name:KAILI
Other - Middle Name:
Other - Last Name:TELMET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BHSC, MSCOT
Mailing Address - Street 1:483 CLERMONT AVENUE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238
Mailing Address - Country:US
Mailing Address - Phone:336-693-2996
Mailing Address - Fax:
Practice Address - Street 1:483 CLERMONT AVENUE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:718-643-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016989225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics