Provider Demographics
NPI:1740586254
Name:JANKOWSKI-WILKINSON, ANDREA FAYE (ATC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:FAYE
Last Name:JANKOWSKI-WILKINSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:FAYE
Other - Last Name:JANKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:NY
Mailing Address - Zip Code:14802-1205
Mailing Address - Country:US
Mailing Address - Phone:330-204-7581
Mailing Address - Fax:607-871-2712
Practice Address - Street 1:1 SAXON DR
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:NY
Practice Address - Zip Code:14802-1205
Practice Address - Country:US
Practice Address - Phone:330-204-7581
Practice Address - Fax:607-871-2712
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0017562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer