Provider Demographics
NPI:1811402290
Name:FAVARO, CATHLEEN M (OTR/L, CDP, CLT)
Entity Type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:M
Last Name:FAVARO
Suffix:
Gender:F
Credentials:OTR/L, CDP, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COLLAMER DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4348
Mailing Address - Country:US
Mailing Address - Phone:518-461-3001
Mailing Address - Fax:
Practice Address - Street 1:41 COLLAMER DR
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-4348
Practice Address - Country:US
Practice Address - Phone:518-461-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016532225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist