Healthcare Provider Details

I. General information

NPI: 1881659878
Provider Name (Legal Business Name): KATHLEEN ROSE LAVELLE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4039 ROUTE 219 SUITE 104
SALAMANCA NY
14779
US

IV. Provider business mailing address

6301 TRANSIT RD
DEPEW NY
14043-1051
US

V. Phone/Fax

Practice location:
  • Phone: 716-945-2484
  • Fax: 716-945-2487
Mailing address:
  • Phone: 716-684-0400
  • Fax: 716-683-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01085001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: