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General NPI Number Information
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NPI Number | 1053221325
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Entity Type | Organization
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Legal Business Name | WE ROCK THE SPECTRUM - ITHACA
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 402 3RD ST STE 1
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City | ITHACA
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State | NY
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Zip | 14850-3484
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Country | US
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Telephone | 607-269-7959
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Fax |
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Provider Business Mailing Address
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Address Line | 402 3RD ST STE 1
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City | ITHACA
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State | NY
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Zip | 14850-3484
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Country | US
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Telephone | 607-269-7959
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA CASEY
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Credential | DO
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Telephone | 607-269-7959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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