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General NPI Number Information
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NPI Number | 1780405050
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Entity Type | Individual
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Provider Name | GAVIN MARSH OT
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Gender | Male
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 6050 ARMOR DUELLS RD
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City | ORCHARD PARK
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State | NY
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Zip | 14127-3126
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Country | US
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Telephone | 607-882-0846
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Fax |
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Provider Business Mailing Address
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Address Line | 812 ADAMS RD
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City | DRYDEN
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State | NY
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Zip | 13053-9613
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Country | US
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Telephone |
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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 | 029269-01
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License Number State | NY
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