Provider Demographics
NPI:1700925427
Name:KANADA, KERRI ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:ANN
Last Name:KANADA
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 1:1 ADLER DR
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1223
Mailing Address - Country:US
Mailing Address - Phone:315-701-7900
Mailing Address - Fax:315-701-7901
Practice Address - Street 1:2100 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2785
Practice Address - Country:US
Practice Address - Phone:585-697-1557
Practice Address - Fax:585-697-5692
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11622225X00000X
NY006412-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889884700Medicaid