Provider Demographics
NPI:1518345040
Name:THERACARE
Entity Type:Organization
Organization Name:THERACARE
Other - Org Name:ATSEI WATKINS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL EDUCATION EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ATSEI
Authorized Official - Middle Name:N
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MAT
Authorized Official - Phone:516-710-3430
Mailing Address - Street 1:565 AVENUE A
Mailing Address - Street 2:UNIT 205
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3200
Mailing Address - Country:US
Mailing Address - Phone:516-710-3430
Mailing Address - Fax:
Practice Address - Street 1:565 AVENUE A
Practice Address - Street 2:UNIT 205
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3200
Practice Address - Country:US
Practice Address - Phone:516-710-3430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719425252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency