Provider Demographics
NPI:1518624212
Name:MACALI- DATTOLI, COLETTE CLAIRE
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:CLAIRE
Last Name:MACALI- DATTOLI
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 1:16 BORGER PL
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1506
Mailing Address - Country:US
Mailing Address - Phone:201-575-2734
Mailing Address - Fax:
Practice Address - Street 1:16 BORGER PL
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1506
Practice Address - Country:US
Practice Address - Phone:201-575-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09190900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant