Provider Demographics
NPI:1821556358
Name:GORGE FALLS THERAPY SLP, OT, PLLC
Entity Type:Organization
Organization Name:GORGE FALLS THERAPY SLP, OT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERNAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:607-437-0141
Mailing Address - Street 1:52 BENJAMIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867-9795
Mailing Address - Country:US
Mailing Address - Phone:607-437-0141
Mailing Address - Fax:
Practice Address - Street 1:225 S FULTON ST STE D
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3344
Practice Address - Country:US
Practice Address - Phone:607-437-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty