Provider Demographics
NPI:1083034201
Name:GREENWAY, KATHERINE JANE
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JANE
Last Name:GREENWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 TANGLEWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3505
Mailing Address - Country:US
Mailing Address - Phone:716-479-0289
Mailing Address - Fax:
Practice Address - Street 1:63 TANGLEWOOD DR W
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-3505
Practice Address - Country:US
Practice Address - Phone:716-479-0289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-27
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY995419252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency