Provider Demographics
NPI:1174895692
Name:WOLF, TERI (OTA)
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CANASERAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14822-9726
Mailing Address - Country:US
Mailing Address - Phone:607-590-1744
Mailing Address - Fax:
Practice Address - Street 1:51 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CANASERAGA
Practice Address - State:NY
Practice Address - Zip Code:14822-9726
Practice Address - Country:US
Practice Address - Phone:607-590-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002290224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant