Provider Demographics
NPI:1023132842
Name:SIEGEL, PATRICIA ANN (OTRL)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 MANEY RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-9721
Mailing Address - Country:US
Mailing Address - Phone:315-789-8250
Mailing Address - Fax:
Practice Address - Street 1:3660 COUNTY ROAD 6
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-9138
Practice Address - Country:US
Practice Address - Phone:315-781-0132
Practice Address - Fax:315-781-0263
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01300001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist