Healthcare Provider Details

I. General information

NPI: 1922165307
Provider Name (Legal Business Name): JACQUELINE L TRIGILIO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JACQUELINE L KUZMA

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

57 WESTGATE RD
KENMORE NY
14217-2317
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3235
  • Fax: 716-898-3259
Mailing address:
  • Phone: 716-873-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number007060-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: