Provider Demographics
NPI:1104297142
Name:TAITT, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:TAITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BEACH 80TH ST
Mailing Address - Street 2:APT. 2 D
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-2002
Mailing Address - Country:US
Mailing Address - Phone:718-636-0461
Mailing Address - Fax:
Practice Address - Street 1:221 BEACH 80TH ST
Practice Address - Street 2:APT 2D
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-2002
Practice Address - Country:US
Practice Address - Phone:718-636-0461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252Y00000XOtherEARLY INTERVENTION PROVIDER