Provider Demographics
NPI:1699051409
Name:SOUVERAIN, KATIA JOLLY (OTR/L, PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KATIA
Middle Name:JOLLY
Last Name:SOUVERAIN
Suffix:
Gender:F
Credentials:OTR/L, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3909
Mailing Address - Country:US
Mailing Address - Phone:347-391-5060
Mailing Address - Fax:
Practice Address - Street 1:972 E 88TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3949
Practice Address - Country:US
Practice Address - Phone:347-203-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63017099225X00000X
NY034140-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist