Provider Demographics
NPI:1366696981
Name:MCDERMOTT, GEORGE MATTHEW (OTR)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MATTHEW
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 W 20TH ST
Mailing Address - Street 2:#3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3604
Mailing Address - Country:US
Mailing Address - Phone:917-923-5722
Mailing Address - Fax:
Practice Address - Street 1:152 W 20TH ST
Practice Address - Street 2:#3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3604
Practice Address - Country:US
Practice Address - Phone:917-923-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005482 1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist