Dominique Bassallo, OT
Individual provider Active NPI Occupational Therapist · Latham, NY
NPI 1972437549 · NPPES record last updated Jun 10, 2026
Key facts
- NPI
- 1972437549
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 031090 (NY)
- Practice address
- 711 Troy Schenectady Rd Ste 216
Latham, NY 12110-2461 - Phone
- (518) 786-1667
- Fax
- (518) 786-1954
- NPI assigned
- Jun 10, 2026
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
711 Troy Schenectady Rd
Suite 209
Latham, NY 12110-2461
711 Troy Schenectady Rd
Suite 209
Latham, NY 12110-2477
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260618002709 | NY | Practitioner - Occupational Therapist in Private Practice | 9335611532 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nicolla and Associates, PT & OT Services, PLLC | Past | Accepting new patients | |
| Thomas Nicolla Consulting Services, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 031090 | NY | Yes |
Addresses
Primary practice location
711 Troy Schenectady Rd Ste 216
Latham, NY 12110-2461
Mailing address
122 Remsen St
Cohoes, NY 12047-2968
Phone (518) 416-3780
Other providers in Latham, NY
- Virginia R Barr
- Amelia Barrett
- Marjorie Stone Barrows
- Gerard Patrick Barry
- Brent Jude Bashaw
- Lisa Battisti
- Richard T Bauer III
- Preeti Bavdekar
- Shawn-Amy Rae Bazargan-Lari
- Ellen Weybright Beals
All providers in Latham, NY · Occupational Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.