Provider Demographics
NPI:1578186599
Name:ABT, KAILENE ANNETTE
Entity Type:Individual
Prefix:
First Name:KAILENE
Middle Name:ANNETTE
Last Name:ABT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 HUNTINGTON BAY RD
Mailing Address - Street 2:
Mailing Address - City:HALESITE
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1335
Mailing Address - Country:US
Mailing Address - Phone:631-806-3555
Mailing Address - Fax:
Practice Address - Street 1:264 HUNTINGTON BAY RD
Practice Address - Street 2:
Practice Address - City:HALESITE
Practice Address - State:NY
Practice Address - Zip Code:11743-1335
Practice Address - Country:US
Practice Address - Phone:631-806-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021238225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021238OtherOCCUPATIONAL THERAPY PROVIDER LICENSE NUMBER