| NPI | 1518421395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRINA TKACHEVA Itds 347-217-5872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2022-01-21 |