Provider Demographics
NPI:1043978679
Name:VACANTE, GABRIELLA MARIA (MS,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:MARIA
Last Name:VACANTE
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8402
Mailing Address - Country:US
Mailing Address - Phone:845-857-6027
Mailing Address - Fax:
Practice Address - Street 1:87 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4437
Practice Address - Country:US
Practice Address - Phone:845-857-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty