Provider Demographics
NPI:1306081583
Name:JAY, KATHLEEN WARFORD (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:WARFORD
Last Name:JAY
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 1:12 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3226
Mailing Address - Country:US
Mailing Address - Phone:516-944-7468
Mailing Address - Fax:
Practice Address - Street 1:12 MONROE ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3226
Practice Address - Country:US
Practice Address - Phone:516-944-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007711225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics