Provider Demographics
NPI:1376866632
Name:MCMAHON, ANTONINA R (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANTONINA
Middle Name:R
Last Name:MCMAHON
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 1:50 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1002
Mailing Address - Country:US
Mailing Address - Phone:716-885-8318
Mailing Address - Fax:716-885-0229
Practice Address - Street 1:6221 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1024
Practice Address - Country:US
Practice Address - Phone:716-681-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015625-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist