Organization
EARLY INTERVENTION PROFESSIONALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE NOCITO (OWNER)
(570) 760-4377
Entity
Organization
Contact information
Practice address
120 WAKEFIELD RD, SHAVERTOWN, PA 18708-9760
(570) 760-4377
Mailing address
120 WAKEFIELD RD, SHAVERTOWN, PA 18708-9760
(570) 760-4377
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017971460002
MEDICAL ASSISTANCE EI
PA
Enumeration date
01/03/2007
Last updated
09/26/2022
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