Provider Demographics
NPI:1720128291
Name:D'AMICO, EILEEN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1550
Mailing Address - Country:US
Mailing Address - Phone:631-563-8929
Mailing Address - Fax:631-563-8929
Practice Address - Street 1:133 YALE AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1550
Practice Address - Country:US
Practice Address - Phone:631-525-2189
Practice Address - Fax:631-563-8929
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004596225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist