Provider Demographics
NPI:1972698298
Name:KOWAL, WILLIAM PETER
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PETER
Last Name:KOWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:SPARROWBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12780-5440
Mailing Address - Country:US
Mailing Address - Phone:845-856-4654
Mailing Address - Fax:
Practice Address - Street 1:606 OLD ROUTE 17
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-7013
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008641225X00000X
PAOC005540L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist