Provider Demographics
NPI:1740562768
Name:JOSEPH, CAROLE ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:ANN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CAYUGA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1707
Mailing Address - Country:US
Mailing Address - Phone:716-897-7800
Mailing Address - Fax:716-270-0160
Practice Address - Street 1:305 CAYUGA CREEK RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14227-1707
Practice Address - Country:US
Practice Address - Phone:716-897-7800
Practice Address - Fax:716-270-0160
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002039-1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-6001643Medicaid