Provider Demographics
NPI:1336681600
Name:GORMAN, KEARA EILEEN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KEARA
Middle Name:EILEEN
Last Name:GORMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4104
Mailing Address - Country:US
Mailing Address - Phone:516-946-9826
Mailing Address - Fax:
Practice Address - Street 1:25 HUDSON RD
Practice Address - Street 2:
Practice Address - City:BELLEROSE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11001-4104
Practice Address - Country:US
Practice Address - Phone:516-946-9826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics