Individual
STACI PEGELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
73 COLDSPRING ST, RANDOLPH, NY 14772-9664
(716) 983-8985
Mailing address
73 COLDSPRING ST, RANDOLPH, NY 14772-9664
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
10/01/2013
Last updated
10/01/2013
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