Provider Demographics
NPI:1336451020
Name:DIMAGGIO, MICHELE ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANN
Last Name:DIMAGGIO
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 1:3000 TEAK HAWK CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1986
Mailing Address - Country:US
Mailing Address - Phone:718-689-0516
Mailing Address - Fax:
Practice Address - Street 1:3220 FEATHERGRASS CT STE 128
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-7788
Practice Address - Country:US
Practice Address - Phone:512-982-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014761-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics