Healthcare Provider Details

I. General information

NPI: 1063122570
Provider Name (Legal Business Name): KATHERINE JANSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2022
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5589 TRANSIT RD
EAST AMHERST NY
14051-1805
US

IV. Provider business mailing address

5589 TRANSIT RD
EAST AMHERST NY
14051-1805
US

V. Phone/Fax

Practice location:
  • Phone: 716-568-1251
  • Fax: 716-568-1253
Mailing address:
  • Phone: 716-568-1251
  • Fax: 716-568-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number027084
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number027084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: