Provider Demographics
NPI:1699272401
Name:GULOTTA, KRISTY (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:GULOTTA
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 1:221 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4515
Mailing Address - Country:US
Mailing Address - Phone:516-496-2743
Mailing Address - Fax:516-496-2780
Practice Address - Street 1:221 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4515
Practice Address - Country:US
Practice Address - Phone:516-496-2743
Practice Address - Fax:516-496-2780
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015365-1225XP0019X, 283Q00000X, 314000000X, 225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No283Q00000XHospitalsPsychiatric Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility