Provider Demographics
NPI:1275934036
Name:FELLOWS, KATRINA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 SELLECK RD
Mailing Address - Street 2:
Mailing Address - City:SAVONA
Mailing Address - State:NY
Mailing Address - Zip Code:14879-9781
Mailing Address - Country:US
Mailing Address - Phone:607-346-4259
Mailing Address - Fax:
Practice Address - Street 1:7280 SELLECK RD
Practice Address - Street 2:
Practice Address - City:SAVONA
Practice Address - State:NY
Practice Address - Zip Code:14879-9781
Practice Address - Country:US
Practice Address - Phone:607-346-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019053225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist