Provider Demographics
NPI:1376149377
Name:CAPEZZUTO, MIRANDA ELIZABETH (OTR)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ELIZABETH
Last Name:CAPEZZUTO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1336
Mailing Address - Country:US
Mailing Address - Phone:908-399-0576
Mailing Address - Fax:
Practice Address - Street 1:60 CENTER ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1336
Practice Address - Country:US
Practice Address - Phone:908-399-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025001OtherNYSED