Provider Demographics
NPI:1669722948
Name:VAGLICA, ERICA (OTR/L)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:VAGLICA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:VENASKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:350 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3547
Mailing Address - Country:US
Mailing Address - Phone:631-867-3100
Mailing Address - Fax:631-867-3108
Practice Address - Street 1:350 DANIEL ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-3547
Practice Address - Country:US
Practice Address - Phone:631-867-3100
Practice Address - Fax:631-867-3108
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011074225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist