Provider Demographics
NPI:1871738096
Name:SCANDIFFIO, DENISE MARIE (MAOTR/L)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:SCANDIFFIO
Suffix:
Gender:F
Credentials:MAOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BEACH 149TH ST
Mailing Address - Street 2:
Mailing Address - City:NEPONSIT
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1025
Mailing Address - Country:US
Mailing Address - Phone:718-634-0343
Mailing Address - Fax:
Practice Address - Street 1:7103 AVENUE T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6244
Practice Address - Country:US
Practice Address - Phone:917-748-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007376-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics