Healthcare Provider Details

I. General information

NPI: 1699377713
Provider Name (Legal Business Name): JULIANE P VENDOLA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 INDUSTRIAL PARK DR
NASHUA NH
03062-3178
US

IV. Provider business mailing address

14 SECOND ST APT A
DOVER NH
03820-7306
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-4500
  • Fax:
Mailing address:
  • Phone: 160-396-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: