Provider Demographics
NPI:1083313217
Name:CANESSA-BISIGNANO, CAMELLIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CAMELLIA
Middle Name:
Last Name:CANESSA-BISIGNANO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CAMELLIA
Other - Middle Name:
Other - Last Name:BISIGNANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 BOULANGER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1103
Mailing Address - Country:US
Mailing Address - Phone:908-528-0545
Mailing Address - Fax:
Practice Address - Street 1:29 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4139
Practice Address - Country:US
Practice Address - Phone:860-549-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6145225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist