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General NPI Number Information
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NPI Number | 1982967113
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Entity Type | Organization
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Legal Business Name | CHILD PRO
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 697 RIDGE RD
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City | LACKAWANNA
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State | NY
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Zip | 14218-1500
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Country | US
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Telephone | 716-822-4781
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Fax |
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Provider Business Mailing Address
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Address Line | 697 RIDGE RD
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City | LACKAWANNA
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State | NY
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Zip | 14218-1500
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Country | US
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Telephone | 716-822-4781
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Fax |
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Authorized Official
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Title or Position | SPECIAL EDUCATION TEACHER
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Name | MRS. MICHELE ELIZABETH ALLEN
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Credential | MSED.
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Telephone | 716-646-1264
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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 | 208888081
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License Number State | NY
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