MEDICARE: GINA SLYDER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	021543	NY

General Provider Information

NPI Number	:	1306350533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA SLYDER OTR/L

Provider Business Mailing Address
First Line	:	2900 DELAWARE AVE
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-2309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 LIMESTONE DR STE 5
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-8601
Country	:	US
Telephone Number	:	716-362-1552
Fax Number	:	716-362-1553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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