=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417658238
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRY TOTS NY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2023
-----------------------------------------------------
Last Update Date | 03/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11525 84TH AVE APT 4M
-----------------------------------------------------
City | RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11418-1413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-338-2869
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11525 84TH AVE APT 4M
-----------------------------------------------------
City | RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11418-1413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-338-2869
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | RAICINE TERRY
-----------------------------------------------------
Credential | MS CCC SLP TSSLD
-----------------------------------------------------
Telephone | 646-338-2869
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------