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General NPI Number Information
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NPI Number | 1487893731
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Entity Type | Organization
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Legal Business Name | IVY TILSON INC
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 655 N BARRY AVE
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City | MAMARONECK
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State | NY
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Zip | 10543-1608
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Country | US
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Telephone | 914-777-1023
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Fax | 914-777-1024
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Provider Business Mailing Address
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Address Line | 655 N BARRY AVE
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City | MAMARONECK
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State | NY
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Zip | 10543-1608
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Country | US
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Telephone | 914-777-1023
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Fax | 914-777-1024
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. IVY W TILSON
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Credential | OTR/L
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Telephone | 914-777-1023
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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 | 0098021
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License Number State | NY
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