=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518624212
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLETTE CLAIRE MACALI- DATTOLI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2021
-----------------------------------------------------
Last Update Date | 11/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 BORGER PL
-----------------------------------------------------
City | PEARL RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10965-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-575-2734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 BORGER PL
-----------------------------------------------------
City | PEARL RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10965-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-575-2734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 46TA09190900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------