Provider Demographics
NPI:1629002217
Name:VENDITTI, TRICIA RENEE (OT)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:RENEE
Last Name:VENDITTI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:RENEE
Other - Last Name:TRAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:812-437-7868
Mailing Address - Fax:812-437-7228
Practice Address - Street 1:5236 VOGEL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7814
Practice Address - Country:US
Practice Address - Phone:812-437-7868
Practice Address - Fax:812-437-7228
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003675A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200865180Medicaid
IL$$$$$$$$$001Medicaid
IL$$$$$$$$$001Medicaid