Active NPI
Darlene Ann Matesic, OTR/L
- Pediatric Occupational Therapist
- Lackawanna, NY
National Provider Identifier
1013164797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 6583254
- Practice address
- 109 Leonard St
Lackawanna, NY 14218-2032 - Phone
- (716) 697-0364
- NPI assigned
- Aug 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 6583254 | NY | Primary |
Addresses
Primary practice location
109 Leonard St
Lackawanna, NY 14218-2032
Mailing address
109 Leonard St
Lackawanna, NY 14218-2032
Phone (716) 697-0364
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6583254 | NY | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305244800000",
"number": "1013164797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 LEONARD ST",
"city": "LACKAWANNA",
"state": "NY",
"postal_code": "142182032",
"telephone_number": "716-697-0364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 LEONARD ST",
"city": "LACKAWANNA",
"state": "NY",
"postal_code": "142182032",
"telephone_number": "716-697-0364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATESIC",
"first_name": "DARLENE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-25",
"last_updated": "2011-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "NY",
"license": "6583254",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackawanna, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.