Provider Demographics
NPI:1124441597
Name:DIDIO, MICHELE (COTA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DIDIO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CORTLAND LN
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-2014
Mailing Address - Country:US
Mailing Address - Phone:716-228-5260
Mailing Address - Fax:
Practice Address - Street 1:61 CORTLAND LN
Practice Address - Street 2:
Practice Address - City:BOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01719-2014
Practice Address - Country:US
Practice Address - Phone:716-228-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA882224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant