=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093170532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTOINETTE CELETTI OTR PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2015
-----------------------------------------------------
Last Update Date | 12/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 ANOROC CT
-----------------------------------------------------
City | CONGERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10920-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-268-0138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 ANOROC COURT
-----------------------------------------------------
City | CONGERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10920-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. ANTOINETTE CELETTI
-----------------------------------------------------
Credential | OTRL
-----------------------------------------------------
Telephone | 845-268-0138
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 007294-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------