Individual
JILL KRISTEN MUMBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
12970 VAN SLYKE RD, EAST CONCORD, NY 14055-9796
(716) 592-9829
Mailing address
12970 VAN SLYKE RD, EAST CONCORD, NY 14055-9796
(716) 592-9829
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
005810-1
NY
Other
Enumeration date
09/08/2011
Last updated
09/08/2011
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