Provider Demographics
NPI:1417576547
Name:DIVERSIFIED SERVICES FOR OCCUPATIONAL THERAPY, PHYSICAL THERAPY, SPEEC
Entity type:Organization
Organization Name:DIVERSIFIED SERVICES FOR OCCUPATIONAL THERAPY, PHYSICAL THERAPY, SPEEC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-871-9883
Mailing Address - Street 1:2900 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2309
Mailing Address - Country:US
Mailing Address - Phone:716-871-9915
Mailing Address - Fax:716-871-9887
Practice Address - Street 1:2900 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2309
Practice Address - Country:US
Practice Address - Phone:716-871-9915
Practice Address - Fax:716-871-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty