Individual
WENDY DISTASIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 PORTLAND AVE, ROCHESTER, NY 14621-3065
(585) 697-6000
Mailing address
312 IMPERIAL CIR, ROCHESTER, NY 14617-3225
(585) 704-5579
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
002956-01
NY
Other
Enumeration date
04/15/2021
Last updated
04/15/2021
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