Individual
KIMBERLY ANNE DEROUCHIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1062 RT. 38, OWEGO, NY 13827
(607) 687-8610
(607) 223-7005
Mailing address
180 SWIFT RD, BINGHAMTON, NY 13905-5723
(607) 687-8610
(607) 223-7005
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
06/20/2012
Last updated
06/20/2012
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