=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609586163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLY SCHRACK OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2022
-----------------------------------------------------
Last Update Date | 11/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1585 HERTEL AVE
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14216-2997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-300-6162
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9143 CHAMPLAIN AVE
-----------------------------------------------------
City | NIAGARA FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14304-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-545-2426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 027065
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------