Provider Demographics
NPI:1528815404
Name:DEVITA, KATELYN ROSE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ROSE
Last Name:DEVITA
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 1:5956 57TH RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2704
Mailing Address - Country:US
Mailing Address - Phone:347-656-3818
Mailing Address - Fax:
Practice Address - Street 1:5956 57TH RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2704
Practice Address - Country:US
Practice Address - Phone:347-656-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029080225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist