MEDICARE: KATIA JOLLY OTR/L, PT, DPT

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	63017099	NY
2	225100000X	Physical Therapist	034140-1	NY

General Provider Information

NPI Number	:	1699051409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIA JOLLY OTR/L, PT, DPT

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 4
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3949
Country	:	US
Telephone Number	:	347-203-7700
Fax Number	:

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

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	04/30/2025

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