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General NPI Number Information
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NPI Number | 1346396249
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Entity Type | Organization
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Legal Business Name | ISLAND THERAPY SPEECH SERVICES
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 95 DURKEE LN
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-5818
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Country | US
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Telephone | 631-286-0343
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6
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City | BELLPORT
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State | NY
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Zip | 11713-0006
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Country | US
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Telephone | 631-286-0343
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROLINE CATHERINE BRABAZON-WILKINSON
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Credential | MSCCCSLP
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Telephone | 631-286-0343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 010393
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License Number State | NY
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