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General NPI Number Information
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NPI Number | 1316311327
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Entity Type | Organization
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Legal Business Name | JULIE MARIE AGRO
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 11/16/2015
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Provider Practice Location Address
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Address Line | 4782 TONAWANDA CREEK RD
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-9534
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Country | US
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Telephone | 716-491-1179
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Fax |
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Provider Business Mailing Address
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Address Line | 4782 TONAWANDA CREEK RD
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-9534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MRS. JULIE M AGRO
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Credential | P.T.
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Telephone | 716-260-2003
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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 | 018398
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License Number State | NY
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