Provider Demographics
NPI:1003273160
Name:THE THERAPY SPOT FOR PEDIATRIC & ADULT SPEECH PHYSICAL OCCUPATIONAL TH
Entity Type:Organization
Organization Name:THE THERAPY SPOT FOR PEDIATRIC & ADULT SPEECH PHYSICAL OCCUPATIONAL TH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:LEPRE
Authorized Official - Last Name:REISCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-582-0088
Mailing Address - Street 1:1770 MOTOR PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5260
Mailing Address - Country:US
Mailing Address - Phone:631-582-0088
Mailing Address - Fax:631-582-0405
Practice Address - Street 1:1770 MOTOR PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5260
Practice Address - Country:US
Practice Address - Phone:631-582-0088
Practice Address - Fax:631-582-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23980252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03539700Medicaid