Provider Demographics
NPI:1740721513
Name:SORRENTINO, CAITLIN (OTR/L)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:SORRENTINO
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 1:21 JAMES P KELLY WAY APT 7
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-9463
Mailing Address - Country:US
Mailing Address - Phone:845-709-0578
Mailing Address - Fax:
Practice Address - Street 1:101 STAGE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3512
Practice Address - Country:US
Practice Address - Phone:845-827-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018330-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist