Provider Demographics
NPI:1639513328
Name:TRUNCELLITO, VANESSA (OTR/L, CAPS)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:TRUNCELLITO
Suffix:
Gender:F
Credentials:OTR/L, CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ELAINE CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1347
Mailing Address - Country:US
Mailing Address - Phone:917-560-9742
Mailing Address - Fax:
Practice Address - Street 1:14 ELAINE CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1347
Practice Address - Country:US
Practice Address - Phone:917-560-9742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017725225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist