Provider Demographics
NPI:1912419532
Name:DUFFY, KATHY ANN (COTA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:DUFFY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-3510
Mailing Address - Country:US
Mailing Address - Phone:201-317-6012
Mailing Address - Fax:
Practice Address - Street 1:39 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3510
Practice Address - Country:US
Practice Address - Phone:201-317-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09143100224Z00000X
NY009318-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant