Provider Demographics
NPI:1073777371
Name:INNOVATIVE THERAPY SOLUTIONS
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WANNAMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:646-922-4002
Mailing Address - Street 1:1330 5TH AVE
Mailing Address - Street 2:6I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3900
Mailing Address - Country:US
Mailing Address - Phone:646-922-4002
Mailing Address - Fax:
Practice Address - Street 1:1330 5TH AVE
Practice Address - Street 2:6I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3900
Practice Address - Country:US
Practice Address - Phone:646-922-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty