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NPI Code Detail

MEDICARE: AMANDA NICOLE DEYO OT

MEDICARE: AMANDA NICOLE DEYO OT
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
1225X00000XOccupational Therapist013398NY

General Provider Information

NPI Number : 1245279611
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA NICOLE DEYO OT
Provider Business Mailing Address
First Line : 127 BEACON RD
Second Line :
City : GLENMONT
State : NY
Zip : 12077-3244
Country : US
Telephone Number : 631-467-3700
Fax Number : 631-467-0928
Provider Business Practice Location Address
First Line : 20 PEACHTREE CT
Second Line : #105
City : HOLBROOK
State : NY
Zip : 11741-4616
Country : US
Telephone Number : 631-467-3700
Fax Number : 631-467-0928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2006
Last Update Date : 06/03/2016

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Directions to “ AMANDA NICOLE DEYO OT” Practice Location

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