MEDICARE: DIVERSIFIED REHABILITATION SERVICES

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	004528-1	NY

General Provider Information

NPI Number	:	1609941368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED REHABILITATION SERVICES

Provider Business Mailing Address
First Line	:	2565 ELMWOOD AVE
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-1939
Country	:	US
Telephone Number	:	716-871-9883
Fax Number	:

Provider Business Practice Location Address
First Line	:	8796 STAHLEY RD
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1585
Country	:	US
Telephone Number	:	716-741-9760
Fax Number	:

Authorized Official
Title or Position	:	OTR
Name	:	DIANE HAMMILL
Credential	:
Telephone Number	:	716-871-9883

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2020

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