Provider Demographics
NPI:1407183296
Name:TELLO, MARY CLAIRE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CLAIRE
Last Name:TELLO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:CLAIRE
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:149 PEPPERTREE DR
Mailing Address - Street 2:APT 2
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2923
Mailing Address - Country:US
Mailing Address - Phone:315-771-9184
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3949
Practice Address - Fax:716-898-3259
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015767225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist