Provider Demographics
NPI:1366509937
Name:GASPER, LUANA M (COTA)
Entity type:Individual
Prefix:MRS
First Name:LUANA
Middle Name:M
Last Name:GASPER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:LUANA
Other - Middle Name:M
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2835
Mailing Address - Country:US
Mailing Address - Phone:716-833-3989
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5040
Practice Address - Fax:716-898-3259
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003719-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant