Provider Demographics
NPI:1619269370
Name:KACZMARSKI, SANDRA LORRAINE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LORRAINE
Last Name:KACZMARSKI
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 1:2824 COVENTRY GRN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5855
Mailing Address - Country:US
Mailing Address - Phone:716-649-3363
Mailing Address - Fax:
Practice Address - Street 1:2824 COVENTRY GREEN
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5855
Practice Address - Country:US
Practice Address - Phone:716-649-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002572-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant