Provider Demographics
NPI:1134339583
Name:IAMMATTEO, DANIELLE LEE (OTRL)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:LEE
Last Name:IAMMATTEO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 HIGHBROOK ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4510
Mailing Address - Country:US
Mailing Address - Phone:914-393-9651
Mailing Address - Fax:
Practice Address - Street 1:1894 HIGHBROOK ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4510
Practice Address - Country:US
Practice Address - Phone:914-393-9651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008986-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist