Individual
MS. MICHELE LYNN MATERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
84 E LAKELAND ST, BAY SHORE, NY 11706-2028
(631) 601-4113
Mailing address
84 E LAKELAND ST, BAY SHORE, NY 11706-2028
(631) 601-4113
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0021391
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS
—
Enumeration date
08/28/2013
Last updated
08/28/2013
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