Individual
KATHLEEN JANET BUSHNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
18 MAIN ST, RANDOLPH, NY 14772-1112
(716) 358-3985
Mailing address
125 JOHNSON ST, GOWANDA, NY 14070-1324
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
002032-1
NY
Other
Enumeration date
09/02/2011
Last updated
09/02/2011
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