Provider Demographics
NPI:1710254560
Name:PIETROSANTO, MOLLIE A
Entity Type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:A
Last Name:PIETROSANTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1625
Mailing Address - Country:US
Mailing Address - Phone:716-646-3350
Mailing Address - Fax:
Practice Address - Street 1:5301 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1625
Practice Address - Country:US
Practice Address - Phone:716-646-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002377-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant