Provider Demographics
NPI:1871244269
Name:CISSE, SALIMATA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SALIMATA
Middle Name:
Last Name:CISSE
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 1:352 DANA FARMS
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-3360
Mailing Address - Country:US
Mailing Address - Phone:774-226-6713
Mailing Address - Fax:
Practice Address - Street 1:352 DANA FARMS
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-3360
Practice Address - Country:US
Practice Address - Phone:774-226-6713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14288225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
EINOtherINTERNAL REVENUE SERVICE (IRS)