Provider Demographics
NPI:1073899613
Name:ROTONDI, RICHARD PAUL (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PAUL
Last Name:ROTONDI
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20104 STATE ROUTE 3
Mailing Address - Street 2:JEFFERSON LEWIS COUNTY BOCES
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9509
Mailing Address - Country:US
Mailing Address - Phone:315-779-7100
Mailing Address - Fax:315-779-7109
Practice Address - Street 1:20104 STATE ROUTE 3
Practice Address - Street 2:JEFFERSON LEWIS COUNTY BOCES
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9509
Practice Address - Country:US
Practice Address - Phone:315-779-7100
Practice Address - Fax:315-779-7109
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012440225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist