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General NPI Number Information
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NPI Number | 1003273160
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Entity Type | Organization
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Legal Business Name | THE THERAPY SPOT FOR PEDIATRIC & ADULT SPEECH PHYSICAL OCCUPATIONAL TH
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 1770 MOTOR PKWY SUITE 202
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City | ISLANDIA
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State | NY
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Zip | 11749-5260
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Country | US
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Telephone | 631-582-0088
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Fax | 631-582-0405
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Provider Business Mailing Address
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Address Line | 1770 MOTOR PKWY SUITE 202
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City | ISLANDIA
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State | NY
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Zip | 11749-5260
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Country | US
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Telephone | 631-582-0088
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Fax | 631-582-0405
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. PHYLLIS LEPRE REISCHMANN
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Credential | P.T.
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Telephone | 631-582-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 23980
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License Number State | NY
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