Healthcare Provider Details

I. General information

NPI: 1053221325
Provider Name (Legal Business Name): WE ROCK THE SPECTRUM - ITHACA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 3RD ST STE 1
ITHACA NY
14850-3484
US

IV. Provider business mailing address

402 3RD ST STE 1
ITHACA NY
14850-3484
US

V. Phone/Fax

Practice location:
  • Phone: 607-269-7959
  • Fax:
Mailing address:
  • Phone: 607-269-7959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JESSICA CASEY
Title or Position: OWNER
Credential: DO
Phone: 607-269-7959