Individual
LAURA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1050 MARYVALE DR, CHEEKTOWAGA, NY 14225-2324
(716) 631-0300
Mailing address
184 CLAREMONT AVE, BUFFALO, NY 14223-2921
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
009431
NY
Other
Enumeration date
08/31/2017
Last updated
08/31/2017
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