Provider Demographics
NPI:1710251616
Name:IAMMATTEO, PATRICIA ANN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:IAMMATTEO
Suffix:
Gender:F
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 1:14701 BETULA WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MD
Mailing Address - Zip Code:21036-1245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14701 BETULA WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MD
Practice Address - Zip Code:21036-1245
Practice Address - Country:US
Practice Address - Phone:301-854-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02228225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics