Healthcare Provider Details

I. General information

NPI: 1467566760
Provider Name (Legal Business Name): SHARON WAGENER ZIMPFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON L WAGENER OTR/L

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FOREST AVE
BUFFALO NY
14213-1207
US

IV. Provider business mailing address

11 RICHMOND AVE
LANCASTER NY
14086-3028
US

V. Phone/Fax

Practice location:
  • Phone: 716-816-2232
  • Fax:
Mailing address:
  • Phone: 716-816-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008901-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number008901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: