Provider Demographics
NPI:1689907487
Name:GERACI, KIM ELLEN (COTA)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:ELLEN
Last Name:GERACI
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 1:1 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-5118
Mailing Address - Country:US
Mailing Address - Phone:914-319-6625
Mailing Address - Fax:
Practice Address - Street 1:1 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-5118
Practice Address - Country:US
Practice Address - Phone:914-319-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007059-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant