MEDICARE: FIRST STEPS SPEECH LANGUAGE PATHOLOGY AND OCCUPATIONAL THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	012239-1	NY

General Provider Information

NPI Number	:	1033364542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STEPS SPEECH LANGUAGE PATHOLOGY AND OCCUPATIONAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	916 THUNDER HILL RD
Second Line	:
City	:	WOODBOURNE
State	:	NY
Zip	:	12788-6618
Country	:	US
Telephone Number	:	845-399-2975
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 THUNDER HILL RD
Second Line	:
City	:	WOODBOURNE
State	:	NY
Zip	:	12788-6618
Country	:	US
Telephone Number	:	845-399-2975
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST/ CO-OWNER
Name	:	MRS. RACHEL JEANNE LA FORGE
Credential	:	MS OTR/L
Telephone Number	:	845-399-2975

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	11/25/2008

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