Provider Demographics
NPI:1720134471
Name:MILESTONES PEDIATRICTHERAPY ,PLLC
Entity Type:Organization
Organization Name:MILESTONES PEDIATRICTHERAPY ,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AMELL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:315-788-5377
Mailing Address - Street 1:16783 IVES STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5312
Mailing Address - Country:US
Mailing Address - Phone:315-788-5377
Mailing Address - Fax:
Practice Address - Street 1:16783 IVES STREET EXT
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5312
Practice Address - Country:US
Practice Address - Phone:315-788-5377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare