Provider Demographics
NPI:1780839191
Name:FARNEY, VICCI LOUISE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:VICCI
Middle Name:LOUISE
Last Name:FARNEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25771 RICH RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5749
Mailing Address - Country:US
Mailing Address - Phone:315-785-8262
Mailing Address - Fax:
Practice Address - Street 1:18564 OUTER WASHINGTON ST.,11, SUITE 5
Practice Address - Street 2:THE ROWLAND CENTER, INC.
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-786-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001641-0225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist