Individual
MISS LEEANNE LICHWICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
101 KLOTHE DR, GRAHAMSVILLE, NY 12740-5805
(845) 985-7080
(845) 985-7070
Mailing address
449 YANKEE LAKE RD, WURTSBORO, NY 12790-2060
(845) 866-5070
(845) 644-4016
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
006083-1
NY
Other
Enumeration date
05/31/2009
Last updated
05/31/2009
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