Provider Demographics
NPI:1134745599
Name:WATTEL, JODI NICOLE (ATR-BC, LCAT)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:NICOLE
Last Name:WATTEL
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 MARION DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5416
Mailing Address - Country:US
Mailing Address - Phone:516-241-5231
Mailing Address - Fax:
Practice Address - Street 1:577 MARION DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-5416
Practice Address - Country:US
Practice Address - Phone:516-241-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001436221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty