Provider Demographics
NPI:1104515592
Name:BOYLE, KATELYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:BOYLE
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 1:28 QUINCY LN
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-8348
Mailing Address - Country:US
Mailing Address - Phone:518-260-3628
Mailing Address - Fax:
Practice Address - Street 1:4573 STATE ROUTE 40
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:NY
Practice Address - Zip Code:12809-3474
Practice Address - Country:US
Practice Address - Phone:518-638-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026590-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist