=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295128197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | O.W.L. ACADEMY, LMSW, SLP, PT & OT LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2015
-----------------------------------------------------
Last Update Date | 03/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1689 GLENMORE AVE
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-2828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-968-5560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1689 GLENMORE AVE
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-2828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-968-5560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O.
-----------------------------------------------------
Name | MRS. GINA ORLOV
-----------------------------------------------------
Credential | M.S.
-----------------------------------------------------
Telephone | 917-968-5560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 112384
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------