Provider Demographics
NPI:1578770178
Name:DAMIAO, JOHN ASSIS (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ASSIS
Last Name:DAMIAO
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 LAKE SHORE DR E
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:NY
Mailing Address - Zip Code:12775-6503
Mailing Address - Country:US
Mailing Address - Phone:845-796-0033
Mailing Address - Fax:
Practice Address - Street 1:641 OLD ROUTE 17
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-7014
Practice Address - Country:US
Practice Address - Phone:845-707-8313
Practice Address - Fax:845-707-8319
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016004-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist