Provider Demographics
NPI:1811280365
Name:DUFFELMEYER, KATHLEEN MARGARET
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARGARET
Last Name:DUFFELMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OLD TOMAHAWK STREET
Mailing Address - Street 2:
Mailing Address - City:GRANITE SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:10527
Mailing Address - Country:US
Mailing Address - Phone:914-243-0501
Mailing Address - Fax:
Practice Address - Street 1:6 OLD TOMAHAWK STREET
Practice Address - Street 2:
Practice Address - City:GRANITE SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:10527
Practice Address - Country:US
Practice Address - Phone:914-243-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007863-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant