Healthcare Provider Details

I. General information

NPI: 1275817975
Provider Name (Legal Business Name): TERRI ANNE SWAYDIS C.O.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 MAIN ST
BUFFALO NY
14214-2152
US

IV. Provider business mailing address

35 HELEN AVE
BLASDELL NY
14219-1711
US

V. Phone/Fax

Practice location:
  • Phone: 716-836-5929
  • Fax: 716-836-6057
Mailing address:
  • Phone: 716-517-1976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number001537-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number001537-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: