MEDICARE: KATRINA IVES

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	224Z00000X	Occupational Therapy Assistant	009837	NY

General Provider Information

NPI Number	:	1144701509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA IVES

Provider Business Mailing Address
First Line	:	100 HILLSIDE DR APT D6
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10941-1333
Country	:	US
Telephone Number	:	518-902-9860
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 ROUTE 32
Second Line	:
City	:	CENTRAL VALLEY
State	:	NY
Zip	:	10917-3201
Country	:	US
Telephone Number	:	845-827-6364
Fax Number	:

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

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	08/23/2018

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