Provider Demographics
NPI:1851687420
Name:LANGDON, KATHLEEN D (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:D
Last Name:LANGDON
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 1:226 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2025
Mailing Address - Country:US
Mailing Address - Phone:716-474-6842
Mailing Address - Fax:
Practice Address - Street 1:226 N 15TH ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2025
Practice Address - Country:US
Practice Address - Phone:716-474-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001704-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker