Individual
MADISON DISTASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
999 OLD EAGLE SCHOOL RD STE 106, WAYNE, PA 19087-1707
(877) 407-3422
(877) 407-4329
Mailing address
7 CARNEGIE PLZ, CHERRY HILL, NJ 08003-1000
(877) 407-3422
(877) 407-4329
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC017263
PA
Other
Enumeration date
11/10/2020
Last updated
01/23/2023
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