Provider Demographics
NPI:1932579091
Name:SCHOBER, KELLY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:SCHOBER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LEANN
Other - Last Name:KLEBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10885 ALLEGANY RD
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14062-9737
Mailing Address - Country:US
Mailing Address - Phone:716-934-7061
Mailing Address - Fax:
Practice Address - Street 1:10885 ALLEGANY RD
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14062-9737
Practice Address - Country:US
Practice Address - Phone:716-934-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008125-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant