Provider Demographics
NPI:1386904738
Name:MALFUCCI, KATHERINE ANNE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANNE
Last Name:MALFUCCI
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 1:1230 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4741
Mailing Address - Country:US
Mailing Address - Phone:917-747-6025
Mailing Address - Fax:
Practice Address - Street 1:195 SANDFORD ST
Practice Address - Street 2:5TH FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4525
Practice Address - Country:US
Practice Address - Phone:718-237-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist