Provider Demographics
NPI:1083017552
Name:KELLEHER, CYNTHIA H (OTR/L)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:H
Last Name:KELLEHER
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 1:5588 STATE HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2081
Mailing Address - Country:US
Mailing Address - Phone:607-353-7272
Mailing Address - Fax:607-286-7166
Practice Address - Street 1:5588 STATE HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2081
Practice Address - Country:US
Practice Address - Phone:607-353-7272
Practice Address - Fax:607-286-7166
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009329-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist