Provider Demographics
NPI:1356639165
Name:INTEGRATED THERAPY OF WNY,OT/PT/SLP,PLLC
Entity Type:Organization
Organization Name:INTEGRATED THERAPY OF WNY,OT/PT/SLP,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:MIKULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:585-343-1840
Mailing Address - Street 1:25 LIBERTY ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3246
Mailing Address - Country:US
Mailing Address - Phone:585-343-1840
Mailing Address - Fax:585-343-2185
Practice Address - Street 1:25 LIBERTY ST STE 5
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3246
Practice Address - Country:US
Practice Address - Phone:585-343-1840
Practice Address - Fax:585-343-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002134-1252Y00000X
NY006394-1252Y00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency