Provider Demographics
NPI:1922452168
Name:CACNIO, THERESA (OTR)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CACNIO
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 1:227 HAVEN AVE
Mailing Address - Street 2:APT 3G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-5309
Mailing Address - Country:US
Mailing Address - Phone:973-216-0875
Mailing Address - Fax:
Practice Address - Street 1:227 HAVEN AVE
Practice Address - Street 2:APT 3G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5309
Practice Address - Country:US
Practice Address - Phone:973-216-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020259225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist