Provider Demographics
NPI:1073035259
Name:WELCH, CATHERINE (COTA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 RONWAY DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8801
Mailing Address - Country:US
Mailing Address - Phone:315-303-5440
Mailing Address - Fax:
Practice Address - Street 1:6575 KIRKVILLE RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9809
Practice Address - Country:US
Practice Address - Phone:315-701-5710
Practice Address - Fax:315-701-5711
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency