Basic Information
| Provider Information | |||||||||
| NPI: | 1902967656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNTLEY | ||||||||
| FirstName: | GARY | ||||||||
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| Credential: | CRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 THORN AVE | ||||||||
| Address2: | SPECTRUM HUMAN SERVICES | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141272600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166622040 | ||||||||
| FaxNumber: | 7166620019 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 ORCHARD PARK RD | ||||||||
| Address2: | SPECTRUM HUMAN SERVICES | ||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142242635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168281719 | ||||||||
| FaxNumber: | 7168289275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225C00000X | 00006407 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
No ID Information.