Healthcare Provider Details

I. General information

NPI: 1033353826
Provider Name (Legal Business Name): KATE HOBAN MITTERWAY MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 BEACH 130TH ST
BELLE HARBOR NY
11694-1524
US

IV. Provider business mailing address

411 BEACH 130TH ST
BELLE HARBOR NY
11694-1524
US

V. Phone/Fax

Practice location:
  • Phone: 917-626-4405
  • Fax:
Mailing address:
  • Phone: 917-626-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number010695-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: