Healthcare Provider Details

I. General information

NPI: 1386479285
Provider Name (Legal Business Name): BOUNCING BUTTERFLIES OT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 CRESCENT RD
CLIFTON PARK NY
12065-7729
US

IV. Provider business mailing address

1536 CRESCENT RD
CLIFTON PARK NY
12065-7729
US

V. Phone/Fax

Practice location:
  • Phone: 518-417-9213
  • Fax:
Mailing address:
  • Phone: 518-417-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MCKENNA FLEMING
Title or Position: OWNER
Credential: MS,OTR/L
Phone: 518-417-9213