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General NPI Number Information
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NPI Number | 1679789929
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Entity Type | Individual
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Provider Name | NIKKI M DEMATTEO OT, CHT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 10/31/2013
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Provider Practice Location Address
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Address Line | 240 PATCHOGUE YAPHANK RD SUITE101
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4868
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Country | US
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Telephone | 631-438-0515
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Fax | 631-438-0516
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Provider Business Mailing Address
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Address Line | 240 PATCHOGUE YAPHANK RD SUITE101
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4868
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Country | US
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Telephone | 631-438-0515
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Fax | 631-438-0516
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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 | 008249
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License Number State | NY
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