MEDICARE: DOLORES CALLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	023646	NY

General Provider Information

NPI Number	:	1083271712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLORES CALLE

Provider Business Mailing Address
First Line	:	3325 96TH ST FL 1
Second Line	:
City	:	CORONA
State	:	NY
Zip	:	11368-1036
Country	:	US
Telephone Number	:	347-599-7306
Fax Number	:

Provider Business Practice Location Address
First Line	:	11506 ROCKAWAY BEACH BLVD
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2346
Country	:	US
Telephone Number	:	718-554-7766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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Directions to “ DOLORES CALLE ” Practice Location

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