Provider Demographics
NPI:1881055713
Name:SIDOTI, MAUREEN (OT/L)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:SIDOTI
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3615
Mailing Address - Country:US
Mailing Address - Phone:516-695-3466
Mailing Address - Fax:
Practice Address - Street 1:2570 NELSON DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-3615
Practice Address - Country:US
Practice Address - Phone:516-695-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-20
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008252-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist