Provider Demographics
NPI:1093001901
Name:VALOIS, CONSTANCE ROSE (OTR)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ROSE
Last Name:VALOIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:R
Other - Last Name:VALOIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:463 MANSE LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1177
Mailing Address - Country:US
Mailing Address - Phone:585-474-4311
Mailing Address - Fax:
Practice Address - Street 1:41 O CONNOR ROAD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-383-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008608-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist