Provider Demographics
NPI:1801261581
Name:CAMASTRO, MARISSA
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:
Last Name:CAMASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:ODDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2094 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3265
Mailing Address - Country:US
Mailing Address - Phone:516-965-2224
Mailing Address - Fax:
Practice Address - Street 1:7 GARDEN BLVD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5924
Practice Address - Country:US
Practice Address - Phone:516-965-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6365225X00000X
NY020095-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist