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General NPI Number Information
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NPI Number | 1073093035
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Entity Type | Organization
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Legal Business Name | GELSOMINO AND DAVIS SPEECH AND OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 5 TRIANGLE RD STE C
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City | LIBERTY
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State | NY
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Zip | 12754
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Country | US
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Telephone | 845-747-2580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 923
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City | LIBERTY
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State | NY
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Zip | 12754-0923
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Country | US
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Telephone | 845-747-2580
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ELIZABETH DAVIS
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Credential |
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Telephone | 845-747-2580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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