Healthcare Provider Details

I. General information

NPI: 1952643942
Provider Name (Legal Business Name): RACHEL COLEGROVE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 TRANSIT RD
WEST SENECA NY
14224-2584
US

IV. Provider business mailing address

3070 TRANSIT RD
WEST SENECA NY
14224-2584
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-1166
  • Fax: 716-668-1466
Mailing address:
  • Phone: 716-668-1166
  • Fax: 716-668-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number012873-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: