Individual
DAN F LITCHOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
146 BROADLEA RD, GOSHEN, NY 10924-5238
(845) 555-5555
Mailing address
PO BOX 264, MARLBORO, NY 12542-0264
(845) 236-3108
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
006761-1
NY
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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