Provider Demographics
NPI:1124500079
Name:SANSONE, EMILY PATRICIA (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:PATRICIA
Last Name:SANSONE
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6834 MINNICK RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-7946
Mailing Address - Country:US
Mailing Address - Phone:716-622-1125
Mailing Address - Fax:
Practice Address - Street 1:4232 SHELBY BASIN RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-9515
Practice Address - Country:US
Practice Address - Phone:716-807-3576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022752225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist