Provider Demographics
NPI:1932975182
Name:LELJEDAL, KAITLYN BEDNAZ (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:BEDNAZ
Last Name:LELJEDAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1716
Mailing Address - Country:US
Mailing Address - Phone:860-550-5594
Mailing Address - Fax:
Practice Address - Street 1:16 DARTTS XRD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NY
Practice Address - Zip Code:14883-9410
Practice Address - Country:US
Practice Address - Phone:607-589-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027638225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist