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General NPI Number Information
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NPI Number | 1609059260
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Entity Type | Organization
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Legal Business Name | INFINITE POSSIBLITIES THERAPY
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 14225 SOUNDVIEW AVE
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City | SOUTHOLD
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State | NY
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Zip | 11971-2751
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Country | US
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Telephone | 631-365-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 14225 SOUNDVIEW AVE
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City | SOUTHOLD
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State | NY
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Zip | 11971-2751
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Country | US
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Telephone | 631-365-4700
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MISS BRIANA L WINDMULLER
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Credential | MS, OTR/L
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Telephone | 631-365-4700
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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 | 014396
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License Number State | NY
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