Basic Information
Provider Information
NPI: 1457010704
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORRISSEY
FirstName: KIERAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 31 E 32ND ST FL 4
Address2:  
City: NEW YORK
State: NY
PostalCode: 100165595
CountryCode: US
TelephoneNumber: 2127592282
FaxNumber: 2123792123
Practice Location
Address1: 630 3RD AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100176705
CountryCode: US
TelephoneNumber: 6468292290
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/14/2021
LastUpdateDate: 12/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X026172NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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