Individual
MRS. GRETCHEN MARIE DIETZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, CKTP
Contact information
Practice address
5544 MAIN ST, 2ND FLOOR, WILLIAMSVILLE, NY 14221-5406
(716) 580-3976
(716) 580-3978
Mailing address
9875 NEW OREGON RD, EDEN, NY 14057-9710
(716) 992-4753
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
012904-1
NY
Other
Enumeration date
09/23/2010
Last updated
09/23/2010
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