Individual
PAULA MARIE DETAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
270 LAKE ST, PENN YAN, NY 14527-1832
(315) 536-2601
Mailing address
4681 ITALY HILL RD, BRANCHPORT, NY 14418-9616
(315) 305-4012
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1487809968
NY
Other
Enumeration date
07/16/2012
Last updated
07/16/2012
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