Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | P06556 | NY |
NPI | 1952821712 |
---|---|
Provider Name | Raquel Paige Vescio |
First Address | Syracuse, NY 13211-1465 |
Second Address | Oswego, NY 13126-6495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2017 |
Last Update Date | 22/06/2017 |