Individual
KIM M BANISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.R.
Contact information
Practice address
8950 SHERIDAN DR, CLARENCE, NY 14031-1420
(716) 633-1924
Mailing address
8950 SHERIDAN DR, CLARENCE, NY 14031-1420
(716) 633-1924
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
009943
NY
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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