Provider Demographics
NPI:1881683910
Name:VRANICH, KATHRYN M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:M
Last Name:VRANICH
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 1:850 N BLOSSOM RD
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9642
Mailing Address - Country:US
Mailing Address - Phone:716-668-9621
Mailing Address - Fax:
Practice Address - Street 1:101 OAK ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2215
Practice Address - Country:US
Practice Address - Phone:716-856-4202
Practice Address - Fax:716-332-3570
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012961225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00639487Medicaid
000670137001OtherBLUE CROSS BLUE SHIELD
9395576OtherINDEPENDANT HEALTH
00030115901OtherUNIVERA
050301000098OtherFIDELIS
000670137001OtherBLUE CROSS BLUE SHIELD
00030115901OtherUNIVERA