Provider Demographics
NPI:1497353759
Name:CAMMARANO, KAITLYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:CAMMARANO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WHITE OAK CT
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1865
Mailing Address - Country:US
Mailing Address - Phone:631-316-1378
Mailing Address - Fax:
Practice Address - Street 1:50 LYNWOOD AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1981
Practice Address - Country:US
Practice Address - Phone:631-696-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025082225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist