Provider Demographics
NPI:1760238257
Name:CANNONE, KATHRYN JEANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JEANNE
Last Name:CANNONE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:TELL
Other - Last Name:CANNONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:102 ELLERY RD
Mailing Address - Street 2:
Mailing Address - City:VILLAS
Mailing Address - State:NJ
Mailing Address - Zip Code:08251-3313
Mailing Address - Country:US
Mailing Address - Phone:609-805-1686
Mailing Address - Fax:
Practice Address - Street 1:400 ROUTE 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5826
Practice Address - Country:US
Practice Address - Phone:609-805-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00103800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist