Basic Information
Provider Information | |||||||||
NPI: | 1003151887 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AYALA | ||||||||
FirstName: | MARGARET | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | TSLD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5820 HERITAGE DR | ||||||||
Address2: |   | ||||||||
City: | EAST SYRACUSE | ||||||||
State: | NY | ||||||||
PostalCode: | 130579378 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3153263351 | ||||||||
FaxNumber: | 3157011131 | ||||||||
Practice Location | |||||||||
Address1: | 159 W 1ST ST | ||||||||
Address2: |   | ||||||||
City: | OSWEGO | ||||||||
State: | NY | ||||||||
PostalCode: | 131262045 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3153263351 | ||||||||
FaxNumber: | 3157011131 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/04/2012 | ||||||||
LastUpdateDate: | 12/04/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X |   |   | Y |   | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
ID Information
ID | Type | State | Issuer | Description | 1207306 | 01 | NY | PUBLIC SCHOOL TEACHER CERTIFICATION | OTHER |