MEDICARE: BUILDING BLOCKS COMPREHENSIVE SERVICES,INC

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	002293-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002293-1	OTHER	NY	COTA REGISTRATION # FPR NY STATE

General Provider Information

NPI Number	:	1700111234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BLOCKS COMPREHENSIVE SERVICES,INC

Provider Business Mailing Address
First Line	:	59 W 5TH STREET RD
Second Line	:
City	:	OSWEGO
State	:	NY
Zip	:	13126-6575
Country	:	US
Telephone Number	:	315-216-6198
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 PARRISH ST
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1785
Country	:	US
Telephone Number	:	565-393-0554
Fax Number	:

Authorized Official
Title or Position	:	OWNER OF BUILDING BLOCKS
Name	:	KELLY BATEMAN
Credential	:	MSED,OTR/L
Telephone Number	:	585-393-0554

Provider Enumeration Date	:	10/16/2009
Last Update Date	:	10/16/2009

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