Provider Demographics
NPI:1679114649
Name:PETRUZZIELLO, VICTORIA LEE (OT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:PETRUZZIELLO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LEE
Other - Last Name:BUETI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:230 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3130
Mailing Address - Country:US
Mailing Address - Phone:609-607-7400
Mailing Address - Fax:609-488-5654
Practice Address - Street 1:230 DIVISION ST
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3130
Practice Address - Country:US
Practice Address - Phone:609-607-7400
Practice Address - Fax:609-488-5654
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00855000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist