Provider Demographics
NPI:1689236572
Name:YACKEVICZ, VANESSA ANN (OTR/L, CPAM)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:ANN
Last Name:YACKEVICZ
Suffix:
Gender:F
Credentials:OTR/L, CPAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 N CIVIC DR APT 182
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3905
Mailing Address - Country:US
Mailing Address - Phone:214-205-0091
Mailing Address - Fax:
Practice Address - Street 1:1449 YGNACIO VALLEY RD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2932
Practice Address - Country:US
Practice Address - Phone:925-939-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17340225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist