Provider Demographics
NPI:1164257853
Name:PELLICCIOTTA, KATELYN ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:ANN
Last Name:PELLICCIOTTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CRESCENT COVE CIR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3643
Mailing Address - Country:US
Mailing Address - Phone:516-477-0798
Mailing Address - Fax:
Practice Address - Street 1:718 THE PLAIN RD STE 3
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5956
Practice Address - Country:US
Practice Address - Phone:516-333-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist