Healthcare Provider Details

I. General information

NPI: 1720993678
Provider Name (Legal Business Name): LUCY EDNA KOWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CLYDE RD
LYONS NY
14489-9364
US

IV. Provider business mailing address

208 CAYUGA ST
UNION SPRINGS NY
13160-3105
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number029272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: