Provider Demographics
NPI:1265887327
Name:ROCCO, MICHAEL (OTR/L)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:ROCCO
Suffix:
Gender:M
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 1:125 JOSEPHINE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2206
Mailing Address - Country:US
Mailing Address - Phone:516-680-5348
Mailing Address - Fax:
Practice Address - Street 1:125 JOSEPHINE AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2206
Practice Address - Country:US
Practice Address - Phone:516-680-5348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist