Provider Demographics
NPI:1497065932
Name:KENEFICK, SANDRA CAROL (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:CAROL
Last Name:KENEFICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:CAROL
Other - Last Name:DOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:29 EAST ONEIDA STREET
Mailing Address - Street 2:BALDWINSVILLE CENTRAL SCHOOL DISTRICT
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027
Mailing Address - Country:US
Mailing Address - Phone:315-635-4500
Mailing Address - Fax:
Practice Address - Street 1:29 EAST ONEIDA STREET
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027
Practice Address - Country:US
Practice Address - Phone:315-635-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000265-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant