Provider Demographics
NPI:1043377849
Name:PARISEAU, AMY LORRAINE (AT,C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LORRAINE
Last Name:PARISEAU
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2329
Mailing Address - Country:US
Mailing Address - Phone:585-671-5572
Mailing Address - Fax:
Practice Address - Street 1:2000 EMPIRE BLVD
Practice Address - Street 2:BLDG 2
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1957
Practice Address - Country:US
Practice Address - Phone:585-671-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001344-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer