MEDICARE: DORSETT-FELICELLI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1417190604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORSETT-FELICELLI

Provider Business Mailing Address
First Line	:	2155 STATE ROUTE 22B
Second Line	:
City	:	MORRISONVILLE
State	:	NY
Zip	:	12962-3417
Country	:	US
Telephone Number	:	518-562-3847
Fax Number	:	518-563-8258

Provider Business Practice Location Address
First Line	:	2155 STATE ROUTE 22B
Second Line	:
City	:	MORRISONVILLE
State	:	NY
Zip	:	12962-3417
Country	:	US
Telephone Number	:	518-562-3847
Fax Number	:	518-563-8258

Authorized Official
Title or Position	:	CLINICAL SERVICES COORDINATOR
Name	:	MRS. MARGI ANN CARTER
Credential	:	SLP
Telephone Number	:	518-562-3847

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	04/17/2009

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