Katie Lynn Connelly, OTR
Individual provider Active NPI Occupational Therapist · Selden, NY
NPI 1104178128 · NPPES record last updated Oct 12, 2021
Key facts
- NPI
- 1104178128
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 017611 (NY)
- Practice address
- 32 Pine St
Selden, NY 11784-2019 - Phone
- (631) 428-1479
- NPI assigned
- Oct 15, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017611 | NY | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 017611 | NY | Yes |
Addresses
Primary practice location
32 Pine St
Selden, NY 11784-2019
Mailing address
32 Pine St
Selden, NY 11784-2019
Phone (631) 428-1479
Other names
- Katie Lynn Mihailovich
Other providers in Selden, NY
- Tarryn Colaiacomo
- Leonard Colin
- Courtney Collingham
- Megan Frances Conklin
- Vincent Thomas Connell
- Steven Conner
- Annemarie Cooper
- Michelle Cooper
- Victoria Marie Coppi
- Coram Selden Dental Group PLLC
All providers in Selden, NY · Occupational Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.