Provider Demographics
NPI:1891943122
Name:MATRECANO, DANIEL F (OT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:F
Last Name:MATRECANO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2532
Mailing Address - Country:US
Mailing Address - Phone:917-428-0963
Mailing Address - Fax:
Practice Address - Street 1:322 LATHROP AVE.
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2532
Practice Address - Country:US
Practice Address - Phone:917-428-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006354-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist