Individual
AMANDA EMILY MATISES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
669 BROADWAY, MASSAPEQUA, NY 11758-2314
(516) 799-2900
Mailing address
8 EASTBOURNE CRES, EAST PATCHOGUE, NY 11772-4838
(631) 569-9337
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024614
NYS OT LICENCE
NY
Enumeration date
05/26/2020
Last updated
11/27/2023
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