Provider Demographics
NPI:1053132779
Name:DOMSTER, ABBY
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:DOMSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13779 GENESEE RD
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:NY
Mailing Address - Zip Code:14030
Mailing Address - Country:US
Mailing Address - Phone:716-353-5992
Mailing Address - Fax:
Practice Address - Street 1:170 ROSEWOOD TERRANCE
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225
Practice Address - Country:US
Practice Address - Phone:716-844-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist