Provider Demographics
NPI:1477701043
Name:AMICO-DZIEZYNSKI, KARYN ANN (OTR/ PT)
Entity type:Individual
Prefix:MRS
First Name:KARYN
Middle Name:ANN
Last Name:AMICO-DZIEZYNSKI
Suffix:
Gender:F
Credentials:OTR/ PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 DENISON RD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1909
Mailing Address - Country:US
Mailing Address - Phone:518-786-8787
Mailing Address - Fax:
Practice Address - Street 1:63 DENISON RD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-1909
Practice Address - Country:US
Practice Address - Phone:518-786-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012014-12251P0200X
NY003502-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics