Provider Demographics
NPI:1285341610
Name:DAMELIO, MICHELLE EMMA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EMMA
Last Name:DAMELIO
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CHARISSAA CT
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-2628
Mailing Address - Country:US
Mailing Address - Phone:973-897-7401
Mailing Address - Fax:
Practice Address - Street 1:450 MAMARONECK AVE STE 412
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-2430
Practice Address - Country:US
Practice Address - Phone:914-686-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027433225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist