Provider Demographics
NPI:1295071348
Name:LONG ISLAND CERTIFIED HAND THERAPY AND CUSTOM ORTHOTICS, OCCUPATIONAL
Entity type:Organization
Organization Name:LONG ISLAND CERTIFIED HAND THERAPY AND CUSTOM ORTHOTICS, OCCUPATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTR/L, CHT
Authorized Official - Phone:631-275-6004
Mailing Address - Street 1:240 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4868
Mailing Address - Country:US
Mailing Address - Phone:631-428-0515
Mailing Address - Fax:631-438-0516
Practice Address - Street 1:240 PATCHOGUE YAPHANK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4868
Practice Address - Country:US
Practice Address - Phone:631-428-0515
Practice Address - Fax:631-438-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008249-1225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty