Provider Demographics
NPI:1457615965
Name:PARRY, VICKI LEE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LEE
Last Name:PARRY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 BAKERSTAND RD
Mailing Address - Street 2:APT. 1
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14737-9729
Mailing Address - Country:US
Mailing Address - Phone:716-307-0229
Mailing Address - Fax:
Practice Address - Street 1:3305 BAKERSTAND RD
Practice Address - Street 2:APT 1
Practice Address - City:FRANKLINVILLE
Practice Address - State:NY
Practice Address - Zip Code:14737-9729
Practice Address - Country:US
Practice Address - Phone:716-307-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006504-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility