Provider Demographics
NPI:1104190297
Name:DANSEREAU, KATHLEEN M (OTR)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:M
Last Name:DANSEREAU
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:1270 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308
Practice Address - Country:US
Practice Address - Phone:518-382-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017249225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist