Provider Demographics
NPI:1669508636
Name:CLINE, AUDREY M (COTA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:M
Last Name:CLINE
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 1:11291 MARKHAM RD
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-9623
Mailing Address - Country:US
Mailing Address - Phone:716-257-5134
Mailing Address - Fax:
Practice Address - Street 1:10714 NORTH RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:NY
Practice Address - Zip Code:14129-9746
Practice Address - Country:US
Practice Address - Phone:716-532-1049
Practice Address - Fax:716-532-0679
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0025801224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant