Provider Demographics
NPI:1265048128
Name:FLYNN, KATHRYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 KENORA PL
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2720
Mailing Address - Country:US
Mailing Address - Phone:516-307-6907
Mailing Address - Fax:
Practice Address - Street 1:718 THE PLAIN RD STE 3
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5956
Practice Address - Country:US
Practice Address - Phone:516-333-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024528-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist