Individual
DYSIRIS MATEO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1240 COLGATE AVE APT 1, BRONX, NY 10472-2340
(347) 981-2317
Mailing address
1240 COLGATE AVE APT 1, BRONX, NY 10472-2340
(347) 981-2317
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
437502
NBCOT
NY
Enumeration date
04/30/2020
Last updated
04/30/2020
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