Provider Demographics
NPI:1679789929
Name:DEMATTEO, NIKKI M (OT, CHT)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:M
Last Name:DEMATTEO
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:SUITE101
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4868
Mailing Address - Country:US
Mailing Address - Phone:631-438-0515
Mailing Address - Fax:631-438-0516
Practice Address - Street 1:240 PATCHOGUE YAPHANK RD
Practice Address - Street 2:SUITE101
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4868
Practice Address - Country:US
Practice Address - Phone:631-438-0515
Practice Address - Fax:631-438-0516
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008249225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist