Provider Demographics
NPI:1275576985
Name:GALDERISI, KATIE ELLEN
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELLEN
Last Name:GALDERISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ELLEN
Other - Last Name:DEDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:277 MILLERS LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4742
Mailing Address - Country:US
Mailing Address - Phone:845-831-2000
Mailing Address - Fax:845-838-5184
Practice Address - Street 1:ROUTE 9D
Practice Address - Street 2:
Practice Address - City:CASTLE POINT
Practice Address - State:NY
Practice Address - Zip Code:12511
Practice Address - Country:US
Practice Address - Phone:845-831-2000
Practice Address - Fax:845-838-5184
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013762-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist