Provider Demographics
NPI:1710253588
Name:DEPERSIIS, VANESSA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:DEPERSIIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7322
Mailing Address - Country:US
Mailing Address - Phone:212-387-0195
Mailing Address - Fax:
Practice Address - Street 1:121 EAST 3RD STREET
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:NY
Practice Address - Zip Code:10009-7322
Practice Address - Country:US
Practice Address - Phone:212-387-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist