Provider Demographics
NPI:1225690472
Name:BUSCH, KRISTEN
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:
Last Name:BUSCH
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 1:8 HIDDEN TRL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9684
Mailing Address - Country:US
Mailing Address - Phone:716-949-9419
Mailing Address - Fax:
Practice Address - Street 1:9822 ROUTE 16
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:NY
Practice Address - Zip Code:14101-9771
Practice Address - Country:US
Practice Address - Phone:716-353-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021169225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist