Provider Demographics
NPI:1891022497
Name:MULLER, KATHRYN ROSA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSA
Last Name:MULLER
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 1:19 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3231
Mailing Address - Country:US
Mailing Address - Phone:518-369-0625
Mailing Address - Fax:
Practice Address - Street 1:105 LAKEHILL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027-9507
Practice Address - Country:US
Practice Address - Phone:518-384-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015693-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist