Provider Demographics
NPI:1104539998
Name:WIGGERS, TONIA
Entity type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:WIGGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:7549 ROUTE 474
Mailing Address - Street 2:
Mailing Address - City:PANAMA
Mailing Address - State:NY
Mailing Address - Zip Code:14767-9626
Mailing Address - Country:US
Mailing Address - Phone:716-365-9783
Mailing Address - Fax:
Practice Address - Street 1:10836 TEMPLE RD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-9610
Practice Address - Country:US
Practice Address - Phone:716-366-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020901-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1528459161Medicaid