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General NPI Number Information
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NPI Number | 1023759545
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Entity Type | Individual
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Provider Name | MOLLY MICHELE CHAMPAGNE-FORTE LMT
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 10225 MAIN ST
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City | CLARENCE
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State | NY
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Zip | 14031-2053
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Country | US
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Telephone | 315-813-2313
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Fax |
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Provider Business Mailing Address
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Address Line | 8588 HUNT AVE
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City | EDEN
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State | NY
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Zip | 14057-1314
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Country | US
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Telephone | 315-813-2313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 031414
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 030580
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License Number State | NY
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