Provider Demographics
NPI:1609941368
Name:DIVERSIFIED REHABILITATION SERVICES
Entity Type:Organization
Organization Name:DIVERSIFIED REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-871-9883
Mailing Address - Street 1:2565 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1939
Mailing Address - Country:US
Mailing Address - Phone:716-871-9883
Mailing Address - Fax:
Practice Address - Street 1:8796 STAHLEY RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1585
Practice Address - Country:US
Practice Address - Phone:716-741-9760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004528-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty