Provider Demographics
NPI:1013164797
Name:MATESIC, DARLENE ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:ANN
Last Name:MATESIC
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 1:109 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-2032
Mailing Address - Country:US
Mailing Address - Phone:716-697-0364
Mailing Address - Fax:
Practice Address - Street 1:109 LEONARD ST
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-2032
Practice Address - Country:US
Practice Address - Phone:716-697-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6583254225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics