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General NPI Number Information
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NPI Number | 1356601462
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Entity Type | Organization
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Legal Business Name | INTEGRATED THERAPY SERVICES 0F WNY,OT/PT/SLP.PLLC
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 25 LIBERTY ST
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City | BATAVIA
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State | NY
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Zip | 14020-3246
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Country | US
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Telephone | 585-343-1840
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Fax | 585-343-2185
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Provider Business Mailing Address
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Address Line | 25 LIBERTY ST
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City | BATAVIA
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State | NY
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Zip | 14020-3246
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Country | US
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Telephone | 585-343-1840
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Fax | 585-343-2185
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARGE MIKULSKI
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Credential | OT
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Telephone | 585-343-1840
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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 | 919212991
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License Number State | NY
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