Provider Demographics
NPI:1770736928
Name:MATTESON, JARROD TODD (OTR)
Entity type:Individual
Prefix:MR
First Name:JARROD
Middle Name:TODD
Last Name:MATTESON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 STATE ROUTE 12B
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NY
Mailing Address - Zip Code:13402-1523
Mailing Address - Country:US
Mailing Address - Phone:315-750-0472
Mailing Address - Fax:
Practice Address - Street 1:4461 STATE ROUTE 12B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NY
Practice Address - Zip Code:13402-1523
Practice Address - Country:US
Practice Address - Phone:315-750-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011827-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics