Provider Demographics
NPI:1518990670
Name:SALERNO, DEIRDRE MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:MARIE
Last Name:SALERNO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ARDEN CRAIG DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4948
Mailing Address - Country:US
Mailing Address - Phone:518-456-0849
Mailing Address - Fax:
Practice Address - Street 1:67 DIVISION ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4099
Practice Address - Country:US
Practice Address - Phone:518-842-2723
Practice Address - Fax:518-842-6573
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02516934Medicaid
NYQ12063Medicare UPIN
NYRA1348Medicare ID - Type Unspecified