Individual
AMANDA MOTISI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
624 HAWKINS AVE, LAKE RONKONKOMA, NY 11779-2375
(631) 240-3579
Mailing address
702 W WALNUT ST, LONG BEACH, NY 11561-2817
(516) 376-7771
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1218218
NY
Other
Enumeration date
07/24/2024
Last updated
07/24/2024
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