Provider Demographics
NPI:1720507551
Name:GORDNIER, KAYLE MIRANDA (COTA/L)
Entity type:Individual
Prefix:MS
First Name:KAYLE
Middle Name:MIRANDA
Last Name:GORDNIER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:240 OCONNOR ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1055
Mailing Address - Country:US
Mailing Address - Phone:585-593-5700
Mailing Address - Fax:585-593-4529
Practice Address - Street 1:240 OCONNOR ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1055
Practice Address - Country:US
Practice Address - Phone:585-593-5700
Practice Address - Fax:585-593-4529
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009326224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant