Healthcare Provider Details

I. General information

NPI: 1104077700
Provider Name (Legal Business Name): MRS. TAMARA SUE LETINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TAMARA SUE DOTEGOWSKI

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10714 NORTH RD
PERRYSBURG NY
14129-9746
US

IV. Provider business mailing address

13963 S HOFFMAN RD APT #1
SPRINGVILLE NY
14141-9770
US

V. Phone/Fax

Practice location:
  • Phone: 716-532-1049
  • Fax: 716-532-0679
Mailing address:
  • Phone: 716-262-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14792-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: