Healthcare Provider Details

I. General information

NPI: 1417083445
Provider Name (Legal Business Name): SUSAN BIDDLECOM OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E AND WEST RD
WEST SENECA NY
14224-3604
US

IV. Provider business mailing address

7130 SALT RD
CLARENCE CENTER NY
14032-9620
US

V. Phone/Fax

Practice location:
  • Phone: 716-517-2000
  • Fax:
Mailing address:
  • Phone: 716-741-2624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0020451
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: