Provider Demographics
NPI:1558683490
Name:COSTABILE, DANA ROSE (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:ROSE
Last Name:COSTABILE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1 SKYLINE DR
Mailing Address - Street 2:SUITE 298
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2157
Mailing Address - Country:US
Mailing Address - Phone:914-347-5990
Mailing Address - Fax:914-347-5236
Practice Address - Street 1:1 SKYLINE DR
Practice Address - Street 2:SUITE 298
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2157
Practice Address - Country:US
Practice Address - Phone:914-347-5990
Practice Address - Fax:914-347-5236
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY016184-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist