Provider Demographics
NPI:1710369780
Name:KOWALSKI, ALISON (MSOT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 SILVER STREET RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-8791
Mailing Address - Country:US
Mailing Address - Phone:315-283-8591
Mailing Address - Fax:
Practice Address - Street 1:3049 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1699
Practice Address - Country:US
Practice Address - Phone:315-445-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P97256252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency