Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 025086 | NY |
N | 225XH1200X | Occupational Therapist - Hand |
NPI | 1245845528 |
---|---|
Provider Name | Colleen Hannon |
First Address | Amherst, NY 14226-1738 |
Second Address | Amherst, NY 14226-1738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2020 |
Last Update Date | 16/10/2020 |