Provider Demographics
NPI:1083128458
Name:ATKINSON, AUTUMN (OTR/L)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREENLEAF MDWS APT C
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-4309
Mailing Address - Country:US
Mailing Address - Phone:585-813-2242
Mailing Address - Fax:
Practice Address - Street 1:30 GREENLEAF MDWS APT C
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-4309
Practice Address - Country:US
Practice Address - Phone:585-813-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021902-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist