Healthcare Provider Details

I. General information

NPI: 1861301376
Provider Name (Legal Business Name): KAELEI ANN SPINA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 E HENRIETTA RD
ROCHESTER NY
14623-2635
US

IV. Provider business mailing address

9411 VERSAILLES PLANK RD
ANGOLA NY
14006-9513
US

V. Phone/Fax

Practice location:
  • Phone: 585-258-3811
  • Fax:
Mailing address:
  • Phone: 716-531-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number031382
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: