MEDICARE: SLP & OT VILLAGE THERAPY PLLC

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	235Z00000X	Speech-Language Pathologist
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1942436365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLP & OT VILLAGE THERAPY PLLC

Provider Business Mailing Address
First Line	:	1529 149TH ST
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-2550
Country	:	US
Telephone Number	:	718-224-3947
Fax Number	:	718-224-3953

Provider Business Practice Location Address
First Line	:	1529 149TH ST
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-2550
Country	:	US
Telephone Number	:	718-224-3947
Fax Number	:	718-224-3953

Authorized Official
Title or Position	:	SPEECH THERAPIST
Name	:	ELIZABETH SKINNER
Credential	:	MS CCC/SLP
Telephone Number	:	717-224-3947

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	06/01/2009

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