Healthcare Provider Details

I. General information

NPI: 1710251616
Provider Name (Legal Business Name): PATRICIA ANN IAMMATTEO M.S., O.T.R./L.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 BETULA WAY
DAYTON MD
21036-1245
US

IV. Provider business mailing address

14701 BETULA WAY
DAYTON MD
21036-1245
US

V. Phone/Fax

Practice location:
  • Phone: 301-854-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number02228
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: