MEDICARE: KATELYNN MARIE SOBREVEGA

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	018714	NY

General Provider Information

NPI Number	:	1164849683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYNN MARIE SOBREVEGA

Provider Business Mailing Address
First Line	:	10 HANOVER SQ APT 21Z
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10005-3574
Country	:	US
Telephone Number	:	516-851-8884
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 PARKSIDE AVE FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-2298
Country	:	US
Telephone Number	:	718-513-2475
Fax Number	:

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

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	12/12/2023

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