Provider Demographics
NPI:1700537867
Name:VACCHIO, KYLA ISABELLA (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:KYLA
Middle Name:ISABELLA
Last Name:VACCHIO
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2535
Mailing Address - Country:US
Mailing Address - Phone:908-812-2033
Mailing Address - Fax:
Practice Address - Street 1:5 ROOSEVELT AVE STE A
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2572
Practice Address - Country:US
Practice Address - Phone:973-507-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01025200225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics