Provider Demographics
NPI:1154567485
Name:MAHONEY, KATIE MERIE (MS,OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MERIE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-3406
Mailing Address - Country:US
Mailing Address - Phone:607-661-2217
Mailing Address - Fax:
Practice Address - Street 1:612 S DECATUR ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1613
Practice Address - Country:US
Practice Address - Phone:607-535-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014298-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist