Provider Demographics
NPI:1417730094
Name:CAMIOLO, MORISSA
Entity Type:Individual
Prefix:
First Name:MORISSA
Middle Name:
Last Name:CAMIOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:POINT LOOKOUT
Mailing Address - State:NY
Mailing Address - Zip Code:11569-0609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 BELLMORE AVENUE
Practice Address - Street 2:
Practice Address - City:POINT LOOKOUT
Practice Address - State:NY
Practice Address - Zip Code:11569
Practice Address - Country:US
Practice Address - Phone:631-664-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027841225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist