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General NPI Number Information
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NPI Number | 1578770178
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Entity Type | Individual
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Provider Name | JOHN ASSIS DAMIAO MS, OTR/L
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 641 OLD ROUTE 17
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City | MONTICELLO
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State | NY
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Zip | 12701-7014
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Country | US
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Telephone | 845-707-8313
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Fax | 845-707-8319
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Provider Business Mailing Address
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Address Line | 57 LAKE SHORE DR E
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City | ROCK HILL
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State | NY
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Zip | 12775-6503
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Country | US
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Telephone | 845-796-0033
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 016004-1
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License Number State | NY
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