Provider Demographics
NPI:1578709333
Name:KLIMENT, ANDREW TAYLOR (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:TAYLOR
Last Name:KLIMENT
Suffix:
Gender:M
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 1:758 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1239
Mailing Address - Country:US
Mailing Address - Phone:607-648-7435
Mailing Address - Fax:
Practice Address - Street 1:174 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1049
Practice Address - Country:US
Practice Address - Phone:607-729-0044
Practice Address - Fax:607-729-9994
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014704-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12275334OtherCAQH
NY1902934904Medicare PIN