MEDICARE: KATHERINE AUBLE OT

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	63015479-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160805	OTHER	AZ	AHCCCS NUMBER

General Provider Information

NPI Number	:	1639211741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE AUBLE OT

Provider Business Mailing Address
First Line	:	27 BIRCH LN
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2301
Country	:	US
Telephone Number	:	315-719-4027
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 MOUNT HOPE AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2251
Country	:	US
Telephone Number	:	928-779-1679
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	03/09/2018

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