Healthcare Provider Details

I. General information

NPI: 1881873578
Provider Name (Legal Business Name): COLLEEN MARIE PANDOLFINO MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SOUTHWESTERN BLVD
HAMBURG NY
14075-1939
US

IV. Provider business mailing address

4650 SOUTHWESTERN BLVD
HAMBURG NY
14075-1939
US

V. Phone/Fax

Practice location:
  • Phone: 716-646-7423
  • Fax: 716-648-7585
Mailing address:
  • Phone: 716-646-7423
  • Fax: 716-648-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number012294-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: