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General NPI Number Information
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NPI Number | 1184342263
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Entity Type | Individual
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Provider Name | MISS EMMA ROSE SHABALA
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Gender | Female
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 40 IRVING PL
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City | NEW YORK
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State | NY
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Zip | 10003-2305
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Country | US
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Telephone | 716-866-0967
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Fax |
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Provider Business Mailing Address
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Address Line | 122 S CAYUGA RD
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City | BUFFALO
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State | NY
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Zip | 14221-6731
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Country | US
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Telephone | 716-866-0967
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 462554
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License Number State | NY
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