Active NPI
Shannen Kolesar, MS, OTR/L
- Occupational Therapist
- Staten Island, NY
National Provider Identifier
1407403876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 023871
- Practice address
- 200 Jefferson Blvd
Staten Island, NY 10312-3329 - Phone
- (929) 284-3318
- NPI assigned
- Aug 21, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 023871 | NY | Primary |
Addresses
Primary practice location
200 Jefferson Blvd
Staten Island, NY 10312-3329
Mailing address
91 Macon Ave
Staten Island, NY 10312-2014
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023871 | NY | MD | Health Service Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639094400000",
"number": "1407403876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91 MACON AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103122014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 JEFFERSON BLVD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103123329",
"telephone_number": "929-284-3318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLESAR",
"first_name": "SHANNEN",
"credential": "MS, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-21",
"last_updated": "2021-12-10",
"certification_date": "2021-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "023871",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.