Healthcare Provider Details

I. General information

NPI: 1700537867
Provider Name (Legal Business Name): KYLA ISABELLA VACCHIO OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ROOSEVELT AVE STE A
CHATHAM NJ
07928-2572
US

IV. Provider business mailing address

90 EASTERN AVE
SOMERVILLE NJ
08876-2535
US

V. Phone/Fax

Practice location:
  • Phone: 973-507-9730
  • Fax:
Mailing address:
  • Phone: 908-812-2033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR01025200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: