Provider Demographics
NPI:1518262732
Name:WAYNE ARC
Entity Type:Organization
Organization Name:WAYNE ARC
Other - Org Name:ROOSEVELT CHILDRENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR OCCUPATIONAL THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHALLMO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:315-331-2086
Mailing Address - Street 1:848 PEIRSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-9762
Mailing Address - Country:US
Mailing Address - Phone:315-331-2086
Mailing Address - Fax:315-331-3215
Practice Address - Street 1:848 PEIRSON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-9762
Practice Address - Country:US
Practice Address - Phone:315-331-2086
Practice Address - Fax:315-331-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002958-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency