Provider Demographics
NPI:1922389717
Name:PHILLIPS, KAREEN KANISHA (OTA)
Entity Type:Individual
Prefix:MISS
First Name:KAREEN
Middle Name:KANISHA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 EWING AVE APT B1
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4253
Mailing Address - Country:US
Mailing Address - Phone:845-290-0231
Mailing Address - Fax:
Practice Address - Street 1:45 PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3401
Practice Address - Country:US
Practice Address - Phone:914-376-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006943224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant