Provider Demographics
NPI:1942832431
Name:GRUBER, KAILEY REBECCA (OTR)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:REBECCA
Last Name:GRUBER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 E 57TH ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2143
Mailing Address - Country:US
Mailing Address - Phone:416-294-2902
Mailing Address - Fax:
Practice Address - Street 1:157 E 57TH ST APT 3F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2143
Practice Address - Country:US
Practice Address - Phone:416-294-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024438-01225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics