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General NPI Number Information
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NPI Number | 1851815757
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Entity Type | Organization
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Legal Business Name | GELSOMINO AND DAVIS SPEECH AND OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 6113 STATE ROUTE 55
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City | LIBERTY
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State | NY
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Zip | 12754-7626
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Country | US
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Telephone | 845-747-2580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 923
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City | LIBERTY
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State | NY
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Zip | 12754-0923
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Country | US
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Telephone | 845-747-2580
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH DAVIS
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Credential | OTR/L
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Telephone | 845-747-2580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 020000
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 014494-1
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License Number State | NY
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