Provider Demographics
NPI:1750432571
Name:JEMIOLO, HOLLY (RN, LMT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:JEMIOLO
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CARRIAGE CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2164
Mailing Address - Country:US
Mailing Address - Phone:716-688-4493
Mailing Address - Fax:
Practice Address - Street 1:BUFFALO CHIROPRACTIC
Practice Address - Street 2:4721 TRANSIT RD
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043
Practice Address - Country:US
Practice Address - Phone:716-688-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010148225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist