Provider Demographics
NPI:1336668953
Name:ESTABROOKS, PAULETTE RUTH (BS ATC)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:RUTH
Last Name:ESTABROOKS
Suffix:
Gender:F
Credentials:BS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SILVERSTEIN RD
Mailing Address - Street 2:
Mailing Address - City:NINEVEH
Mailing Address - State:NY
Mailing Address - Zip Code:13813-1135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 SILVERSTEIN RD
Practice Address - Street 2:
Practice Address - City:NINEVEH
Practice Address - State:NY
Practice Address - Zip Code:13813-1135
Practice Address - Country:US
Practice Address - Phone:607-242-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0022732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer