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NPI Code Detail

MEDICARE: AMANDA EMILY MATISES

MEDICARE: AMANDA EMILY MATISES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1024614OTHERNYNYS OT LICENCE

General Provider Information

NPI Number : 1033732060
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA EMILY MATISES
Provider Business Mailing Address
First Line : 8 EASTBOURNE CRES
Second Line :
City : EAST PATCHOGUE
State : NY
Zip : 11772-4838
Country : US
Telephone Number : 631-569-9337
Fax Number :
Provider Business Practice Location Address
First Line : 669 BROADWAY
Second Line :
City : MASSAPEQUA
State : NY
Zip : 11758-2314
Country : US
Telephone Number : 516-799-2900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2020
Last Update Date : 11/27/2023

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Directions to “ AMANDA EMILY MATISES ” Practice Location

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