Provider Demographics
NPI:1720703929
Name:CARDAMONE, GRACE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CARDAMONE
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 1:96 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-2240
Mailing Address - Country:US
Mailing Address - Phone:607-382-7416
Mailing Address - Fax:
Practice Address - Street 1:96 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2240
Practice Address - Country:US
Practice Address - Phone:406-201-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NY029743-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist