Provider Demographics
NPI:1669864310
Name:VITELLI, CARYSSA (MS, OTR)
Entity Type:Individual
Prefix:
First Name:CARYSSA
Middle Name:
Last Name:VITELLI
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WHISPERING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-3404
Mailing Address - Country:US
Mailing Address - Phone:908-240-7727
Mailing Address - Fax:
Practice Address - Street 1:21 WHISPERING HILLS DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3404
Practice Address - Country:US
Practice Address - Phone:908-240-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00673100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist