Provider Demographics
NPI:1053559963
Name:TIME TO GROW SERVICES OT, PT, SLP AUDIOLOGY AND PSYCHOLOGY PLLC
Entity type:Organization
Organization Name:TIME TO GROW SERVICES OT, PT, SLP AUDIOLOGY AND PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:716-692-1049
Mailing Address - Street 1:603 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4461
Mailing Address - Country:US
Mailing Address - Phone:716-692-1049
Mailing Address - Fax:716-692-1875
Practice Address - Street 1:603 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4461
Practice Address - Country:US
Practice Address - Phone:716-692-1049
Practice Address - Fax:716-692-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0058551252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency