Healthcare Provider Details

I. General information

NPI: 1801573852
Provider Name (Legal Business Name): 315 THERAPY FOR PT, OT AND SLP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 07/12/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W 1ST STREET
OSWEGO NY
13126
US

IV. Provider business mailing address

155 W 1ST STREET
OSWEGO NY
13126
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-9575
  • Fax:
Mailing address:
  • Phone: 315-342-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL WEAVER
Title or Position: COO
Credential:
Phone: 315-529-0793