Provider Demographics
NPI:1619334356
Name:SPECHT, CORTLIN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:CORTLIN
Middle Name:
Last Name:SPECHT
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:CORTLIN
Other - Middle Name:
Other - Last Name:MAUTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:2049 GEORGE URBAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1823
Mailing Address - Country:US
Mailing Address - Phone:716-901-8700
Mailing Address - Fax:
Practice Address - Street 1:2049 GEORGE URBAN BLVD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1823
Practice Address - Country:US
Practice Address - Phone:716-901-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020046-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics