Individual
MRS. LISA JUERGENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2495 MAIN ST STE 234, BUFFALO, NY 14214-2152
(716) 836-5929
Mailing address
236 RIDGEWOOD DR, AMHERST, NY 14226-4942
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
003075-1
NY
Other
Enumeration date
06/04/2010
Last updated
06/11/2010
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