Provider Demographics
NPI:1477830719
Name:KAHN, CAROL B (COTA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:KAHN
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 1:1626 BALLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2304
Mailing Address - Country:US
Mailing Address - Phone:518-382-2525
Mailing Address - Fax:518-382-2526
Practice Address - Street 1:1626 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-2304
Practice Address - Country:US
Practice Address - Phone:518-382-2525
Practice Address - Fax:518-382-2526
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003156-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant