Provider Demographics
NPI:1992935324
Name:KATSKILL KIDS PT, SLP, OT, RN, PSYCHOLOGY & LMSW
Entity type:Organization
Organization Name:KATSKILL KIDS PT, SLP, OT, RN, PSYCHOLOGY & LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:845-985-7080
Mailing Address - Street 1:101 KLOTHE DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12740-5805
Mailing Address - Country:US
Mailing Address - Phone:845-985-7080
Mailing Address - Fax:845-985-7070
Practice Address - Street 1:7922 STATE ROUTE 55
Practice Address - Street 2:
Practice Address - City:GRAHAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12740-6409
Practice Address - Country:US
Practice Address - Phone:845-985-7080
Practice Address - Fax:845-985-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014573-1251E00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251E00000XAgenciesHome Health