Provider Demographics
NPI:1245522804
Name:D'AMICO, MARIANA (EDD, OTR/L)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:EDD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 CALBRIETH WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-8600
Mailing Address - Country:US
Mailing Address - Phone:803-442-3677
Mailing Address - Fax:
Practice Address - Street 1:3624 OLD PETERSBURG ROAD
Practice Address - Street 2:SENSATIONAL KIDS PEDIATRIC REHABILITATION CENTER INC
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2865
Practice Address - Country:US
Practice Address - Phone:706-364-3470
Practice Address - Fax:706-364-3470
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist