Provider Demographics
NPI:1306176516
Name:DEYO, KATHLEEN M (MS)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:DEYO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 E 78TH ST
Mailing Address - Street 2:APT 2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1690
Mailing Address - Country:US
Mailing Address - Phone:917-684-5314
Mailing Address - Fax:
Practice Address - Street 1:418 E 78TH ST
Practice Address - Street 2:APT 2D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1690
Practice Address - Country:US
Practice Address - Phone:917-684-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist