Healthcare Provider Details

I. General information

NPI: 1942436365
Provider Name (Legal Business Name): SLP & OT VILLAGE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 149TH ST
WHITESTONE NY
11357-2550
US

IV. Provider business mailing address

1529 149TH ST
WHITESTONE NY
11357-2550
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-3947
  • Fax: 718-224-3953
Mailing address:
  • Phone: 718-224-3947
  • Fax: 718-224-3953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH SKINNER
Title or Position: SPEECH THERAPIST
Credential: MS CCC/SLP
Phone: 717-224-3947