Provider Demographics
NPI:1669623138
Name:RIEDERER, AMY JEANETTE (BA OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEANETTE
Last Name:RIEDERER
Suffix:
Gender:F
Credentials:BA OTR/L
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:JEANETTE
Other - Last Name:PATERIO-HANKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA OTR/L
Mailing Address - Street 1:252 HENNEPIN RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2325
Mailing Address - Country:US
Mailing Address - Phone:716-774-8329
Mailing Address - Fax:
Practice Address - Street 1:252 HENNEPIN RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2325
Practice Address - Country:US
Practice Address - Phone:716-774-8329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012651225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist