MEDICARE: PATRICIA ANN IAMMATTEO M.S., O.T.R./L.

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
1	225XP0200X	Pediatric Occupational Therapist	02228	MD

General Provider Information

NPI Number	:	1710251616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ANN IAMMATTEO M.S., O.T.R./L.

Provider Business Mailing Address
First Line	:	14701 BETULA WAY
Second Line	:
City	:	DAYTON
State	:	MD
Zip	:	21036-1245
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14701 BETULA WAY
Second Line	:
City	:	DAYTON
State	:	MD
Zip	:	21036-1245
Country	:	US
Telephone Number	:	301-854-0005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	02/24/2012

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