Healthcare Provider Details

I. General information

NPI: 1790099208
Provider Name (Legal Business Name): KRISTEN M ROVELLO OTR/L, ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOCES DR
YORKTOWN HEIGHTS NY
10598-4321
US

IV. Provider business mailing address

207 PEMBERWICK RD
GREENWICH CT
06831-4228
US

V. Phone/Fax

Practice location:
  • Phone: 914-248-2250
  • Fax:
Mailing address:
  • Phone: 203-532-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008696-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: