Provider Demographics
NPI:1669022430
Name:RANALLO, MADALYN BROOKE (COTA)
Entity Type:Individual
Prefix:
First Name:MADALYN
Middle Name:BROOKE
Last Name:RANALLO
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 1:11390 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1017
Mailing Address - Country:US
Mailing Address - Phone:951-264-3322
Mailing Address - Fax:
Practice Address - Street 1:11390 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1017
Practice Address - Country:US
Practice Address - Phone:716-580-3040
Practice Address - Fax:716-580-3042
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010248224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant