Provider Demographics
NPI:1851423214
Name:OTSEGO COUNTY EARLY INTERVENTION
Entity Type:Organization
Organization Name:OTSEGO COUNTY EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-547-6474
Mailing Address - Street 1:140 CO HWY 33W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326
Mailing Address - Country:US
Mailing Address - Phone:607-547-6474
Mailing Address - Fax:607-547-6402
Practice Address - Street 1:140 COUNTY HIGHWAY 33W
Practice Address - Street 2:SUITE 3
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-4953
Practice Address - Country:US
Practice Address - Phone:607-547-6474
Practice Address - Fax:607-547-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00321917Medicaid