Provider Demographics
NPI:1649318502
Name:VINTALORO, LISA MARIE (OT)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:MARIE
Last Name:VINTALORO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 SHORE RD APT 4H
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5407
Mailing Address - Country:US
Mailing Address - Phone:631-252-7580
Mailing Address - Fax:
Practice Address - Street 1:885 HAMPSHIRE RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7631
Practice Address - Country:US
Practice Address - Phone:631-968-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012994225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist