Provider Demographics
NPI:1790304954
Name:COLE, KELSEY (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 FERNICK CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1877
Mailing Address - Country:US
Mailing Address - Phone:845-427-1711
Mailing Address - Fax:
Practice Address - Street 1:2 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-1000
Practice Address - Country:US
Practice Address - Phone:845-651-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024662225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics