Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 019114 | NY |
NPI | 1033511555 |
---|---|
Provider Name | Lisa Maderer |
First Address | Amherst, NY 14226-1444 |
Second Address | Amherst, NY 14226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2014 |
Last Update Date | 29/05/2018 |