Healthcare Provider Details

I. General information

NPI: 1962913905
Provider Name (Legal Business Name): PHILIP JOHN WOJTAS OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8637 MAIN ST
WILLIAMSVILLE NY
14221-7501
US

IV. Provider business mailing address

8637 MAIN ST
WILLIAMSVILLE NY
14221-7501
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-1578
  • Fax: 716-634-3947
Mailing address:
  • Phone: 716-634-1578
  • Fax: 716-634-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number387576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: