Individual
AMANDA SHIRLEY WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
50 EAST NORTH STREET, BUFFALO, NY 14203
(716) 885-8318
(716) 885-0229
Mailing address
3119 SMITH RD, CASSADAGA, NY 14718-9640
(716) 474-5232
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
007631-1
NY
Other
Enumeration date
01/02/2013
Last updated
01/02/2013
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