Provider Demographics
NPI:1194107094
Name:REIMONDO, MOLLY KATHRYN
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHRYN
Last Name:REIMONDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5337
Mailing Address - Country:US
Mailing Address - Phone:716-472-3995
Mailing Address - Fax:
Practice Address - Street 1:4430 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5337
Practice Address - Country:US
Practice Address - Phone:716-472-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018292-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist