Provider Demographics
NPI:1932470382
Name:MASTROGIOVANNI, DINA M (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:M
Last Name:MASTROGIOVANNI
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 1:203 JARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4226
Mailing Address - Country:US
Mailing Address - Phone:215-266-5742
Mailing Address - Fax:
Practice Address - Street 1:203 JARRETT AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4226
Practice Address - Country:US
Practice Address - Phone:215-266-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003061L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist