Healthcare Provider Details

I. General information

NPI: 1194929307
Provider Name (Legal Business Name): WONDER YEARS CHILD DEVELOPMENT OT PT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 S MAIN ST
PEARL RIVER NY
10965-2427
US

IV. Provider business mailing address

52 S MAIN ST
PEARL RIVER NY
10965-2427
US

V. Phone/Fax

Practice location:
  • Phone: 845-920-8622
  • Fax: 845-920-8619
Mailing address:
  • Phone: 845-920-8622
  • Fax: 845-920-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNE MARIE PITRELLI
Title or Position: OFFICE MANAGER
Credential: MSPT
Phone: 845-920-8622