Provider Demographics
NPI:1457656936
Name:FRASER, MARLENE ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:ANN
Last Name:FRASER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12510 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:NY
Mailing Address - Zip Code:14134-9703
Mailing Address - Country:US
Mailing Address - Phone:716-496-5425
Mailing Address - Fax:
Practice Address - Street 1:2495 MAIN ST
Practice Address - Street 2:234
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2152
Practice Address - Country:US
Practice Address - Phone:716-836-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000989-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant