Healthcare Provider Details

I. General information

NPI: 1104788660
Provider Name (Legal Business Name): ALLISA J SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 7TH ST
BUFFALO NY
14201-2161
US

IV. Provider business mailing address

387 ADAM ST
TONAWANDA NY
14150-1903
US

V. Phone/Fax

Practice location:
  • Phone: 716-847-2500
  • Fax:
Mailing address:
  • Phone: 716-471-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number028227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: