Provider Demographics
NPI:1356581367
Name:SOUTHTOWNS CHILDREN'S SLP, PT & OT ASSOCIATES
Entity type:Organization
Organization Name:SOUTHTOWNS CHILDREN'S SLP, PT & OT ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOWAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-794-3535
Mailing Address - Street 1:3755 ABBOTT ROAD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2115
Mailing Address - Country:US
Mailing Address - Phone:716-202-1161
Mailing Address - Fax:716-202-4423
Practice Address - Street 1:3755 ABBOTT ROAD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2115
Practice Address - Country:US
Practice Address - Phone:716-202-1161
Practice Address - Fax:716-202-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012225252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency