Provider Demographics
NPI:1457367096
Name:FEDERICO, JULISSA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JULISSA
Middle Name:
Last Name:FEDERICO
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 1:1940 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4428
Mailing Address - Country:US
Mailing Address - Phone:914-631-9020
Mailing Address - Fax:914-631-9028
Practice Address - Street 1:1940 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4428
Practice Address - Country:US
Practice Address - Phone:914-631-9020
Practice Address - Fax:914-631-9028
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00463600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX981Medicare ID - Type Unspecified