Provider Demographics
NPI:1881020071
Name:MANGUS, KAYSE ANN (MS)
Entity Type:Individual
Prefix:
First Name:KAYSE
Middle Name:ANN
Last Name:MANGUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 ELMWOOD AVE
Mailing Address - Street 2:SUITE 740
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2202
Mailing Address - Country:US
Mailing Address - Phone:905-941-4586
Mailing Address - Fax:
Practice Address - Street 1:845 DAYTONA DR
Practice Address - Street 2:
Practice Address - City:FORT ERIE
Practice Address - State:ONTARIO
Practice Address - Zip Code:L2A 4Z7
Practice Address - Country:CA
Practice Address - Phone:905-871-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP90524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist