Individual
MICHELLE VANNELLI KASOUF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7704 BLACK WILLOW, LIVERPOOL, NY 13090-3600
(315) 935-4341
Mailing address
7704 BLACK WILLOW, LIVERPOOL, NY 13090-3600
(315) 935-4341
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
785301131
NY
Other
Enumeration date
10/31/2013
Last updated
10/31/2013
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