Provider Demographics
NPI:1942436365
Name:SLP & OT VILLAGE THERAPY PLLC
Entity Type:Organization
Organization Name:SLP & OT VILLAGE THERAPY PLLC
Other - Org Name:THERAPY VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:717-224-3947
Mailing Address - Street 1:1529 149TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2550
Mailing Address - Country:US
Mailing Address - Phone:718-224-3947
Mailing Address - Fax:718-224-3953
Practice Address - Street 1:1529 149TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2550
Practice Address - Country:US
Practice Address - Phone:718-224-3947
Practice Address - Fax:718-224-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty