Provider Demographics
NPI:1235381195
Name:DIBELLO, MAUREEN STUDDERT (OT)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:STUDDERT
Last Name:DIBELLO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:ANN
Other - Last Name:STUDDERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:34 LOGAN RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1926
Mailing Address - Country:US
Mailing Address - Phone:845-621-4338
Mailing Address - Fax:845-621-4338
Practice Address - Street 1:34 LOGAN RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1926
Practice Address - Country:US
Practice Address - Phone:845-621-4338
Practice Address - Fax:845-621-4338
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003532-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics