Provider Demographics
NPI:1427539634
Name:STOKLOSA, KATHLEEN B (OTD, MPA, OT/L)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:B
Last Name:STOKLOSA
Suffix:
Gender:F
Credentials:OTD, MPA, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BEACH FLINT WAY
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8965
Mailing Address - Country:US
Mailing Address - Phone:585-402-3877
Mailing Address - Fax:
Practice Address - Street 1:23 BEACH FLINT WAY
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-8965
Practice Address - Country:US
Practice Address - Phone:585-402-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04643-1225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation