Basic Information
| Provider Information | |||||||||
| NPI: | 1174280655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COPELAND | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 519 | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136010519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157823941 | ||||||||
| FaxNumber: | 3157823816 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 COUNTY ROUTE 64 | ||||||||
| Address2: | |||||||||
| City: | MEXICO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131143229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3159630864 | ||||||||
| FaxNumber: | 3159637693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2021 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 026236 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.