Provider Demographics
NPI:1316437726
Name:SCOTT MAIALE, JACLYN D
Entity type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:D
Last Name:SCOTT MAIALE
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 1:95 JOHN MUIR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1144
Mailing Address - Country:US
Mailing Address - Phone:716-250-4137
Mailing Address - Fax:
Practice Address - Street 1:95 JOHN MUIR DRIVE, SUITE 100
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228
Practice Address - Country:US
Practice Address - Phone:716-250-4137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009557-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant