MEDICARE: KORE OT & PT, PLLC

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	63 017099	NY
2	225XE0001X	Environmental Modification Occupational Therapist	63 017099	NY
3	225XE1200X	Ergonomics Occupational Therapist	63 017099	NY
4	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	63 017099	NY
5	225XP0200X	Pediatric Occupational Therapist	63 017099	NY
6	225XP0019X	Physical Rehabilitation Occupational Therapist	63 017099	NY
7	2251C2600X	Cardiopulmonary Physical Therapist	034140-1	NY
8	2251E1200X	Ergonomics Physical Therapist	034140-1	NY
9	2251G0304X	Geriatric Physical Therapist	034140-1	NY
10	2251N0400X	Neurology Physical Therapist	034140-1	NY
11	2251X0800X	Orthopedic Physical Therapist	034140-1	NY
12	2251P0200X	Pediatric Physical Therapist	034140-1	NY
13	2251S0007X	Sports Physical Therapist	034140-1	NY
14	225100000X	Physical Therapist	034140-1	NY

General Provider Information

NPI Number	:	1417369380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KORE OT & PT, PLLC

Provider Business Mailing Address
First Line	:	942 E 87TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3909
Country	:	US
Telephone Number	:	347-391-5060
Fax Number	:

Provider Business Practice Location Address
First Line	:	972 E 88TH ST
Second Line	:	SUITE 004
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3949
Country	:	US
Telephone Number	:	347-391-5060
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KATIA JOLLY SOUVERAIN
Credential	:	PT, OTR/L, MBA, CEAS
Telephone Number	:	347-391-5060

Provider Enumeration Date	:	05/28/2014
Last Update Date	:	05/29/2014

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