Provider Demographics
NPI:1265073332
Name:ADEROUNMU, KATHARINE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:ADEROUNMU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:DOVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:430 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5278
Practice Address - Country:US
Practice Address - Phone:607-437-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0706186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist