Provider Demographics
NPI:1942846209
Name:CONSTANCE, ANTHONY (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:CONSTANCE
Suffix:
Gender:M
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 1:5144 SHERIDAN DR
Mailing Address - Street 2:STE 2
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4653
Mailing Address - Country:US
Mailing Address - Phone:716-631-5224
Mailing Address - Fax:716-631-5626
Practice Address - Street 1:EXCELSIOR ORTHOPAEDICS
Practice Address - Street 2:3925 SHERIDAN DRIVE
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-250-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023917225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist