Healthcare Provider Details

I. General information

NPI: 1528862844
Provider Name (Legal Business Name): JESSICA L VUOLO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DATES DR
ITHACA NY
14850-1342
US

IV. Provider business mailing address

586 W DRYDEN RD APT 2
FREEVILLE NY
13068-5712
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-4011
  • Fax:
Mailing address:
  • Phone: 585-857-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number025126
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: