Healthcare Provider Details

I. General information

NPI: 1730965922
Provider Name (Legal Business Name): HANNAH PACHECO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 FAIRMOUNT AVE
JAMESTOWN NY
14701-2609
US

IV. Provider business mailing address

774 FAIRMOUNT AVE
JAMESTOWN NY
14701-2609
US

V. Phone/Fax

Practice location:
  • Phone: 716-338-0668
  • Fax: 716-665-1160
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: