Individual
MELANIE LAUREN DISTURCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6445 W QUAKER ST, ORCHARD PARK, NY 14127-2354
(716) 667-9377
Mailing address
45 ASBURY PL, DEPEW, NY 14043-1611
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
009435-1
NY
Other
Enumeration date
09/07/2017
Last updated
09/07/2017
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