=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851544399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEBORAH ULBRIGHT, D.B.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2008
-----------------------------------------------------
Last Update Date | 10/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6596 GROVELAND HILL RD
-----------------------------------------------------
City | GROVELAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14462-9515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-243-0617
-----------------------------------------------------
Fax | 585-243-0617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6596 GROVELAND HILL RD
-----------------------------------------------------
City | GROVELAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14462-9515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-243-0617
-----------------------------------------------------
Fax | 585-243-0617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH/LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. DEBORAH T. ULBRIGHT
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 607-382-1054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 005504-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------