Provider Demographics
NPI:1427490051
Name:DELGADO, LISSETTE MARCELLE (OT)
Entity type:Individual
Prefix:
First Name:LISSETTE
Middle Name:MARCELLE
Last Name:DELGADO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7844 80TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7659
Mailing Address - Country:US
Mailing Address - Phone:347-731-4034
Mailing Address - Fax:
Practice Address - Street 1:7844 80TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7659
Practice Address - Country:US
Practice Address - Phone:347-731-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018168225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist