Provider Demographics
NPI:1952821712
Name:VESCIO, RAQUEL PAIGE
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:PAIGE
Last Name:VESCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13211-1465
Mailing Address - Country:US
Mailing Address - Phone:315-484-8914
Mailing Address - Fax:
Practice Address - Street 1:20 MANOR DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6495
Practice Address - Country:US
Practice Address - Phone:315-349-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP06556225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology