Healthcare Provider Details

I. General information

NPI: 1275251662
Provider Name (Legal Business Name): HALEY ROSE ATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MARYVALE DR
CHEEKTOWAGA NY
14225-2324
US

IV. Provider business mailing address

1801 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-2249
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-0300
  • Fax:
Mailing address:
  • Phone: 716-773-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number027032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: