MEDICARE: KATHERINE O'CONNELL HUBBELL

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	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1184148272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE O'CONNELL HUBBELL

Provider Business Mailing Address
First Line	:	1385 COACH RD
Second Line	:
City	:	ARGYLE
State	:	NY
Zip	:	12809-3811
Country	:	US
Telephone Number	:	518-638-8353
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 LOWER OAK ST
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-2676
Country	:	US
Telephone Number	:	518-480-3351
Fax Number	:

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

Provider Enumeration Date	:	07/31/2017
Last Update Date	:	07/21/2022

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