Provider Demographics
NPI:1952528119
Name:PROUTY, PATTI L (OTR)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:L
Last Name:PROUTY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BREWER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3918
Mailing Address - Country:US
Mailing Address - Phone:315-379-9247
Mailing Address - Fax:
Practice Address - Street 1:205 STATE STREET RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3302
Practice Address - Country:US
Practice Address - Phone:315-386-4541
Practice Address - Fax:315-229-4872
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist