Healthcare Provider Details

I. General information

NPI: 1043978679
Provider Name (Legal Business Name): GABRIELLA MARIA VACANTE MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 OLD ROUTE 17
MONTICELLO NY
12701-7013
US

IV. Provider business mailing address

606 OLD ROUTE 17
MONTICELLO NY
12701-7013
US

V. Phone/Fax

Practice location:
  • Phone: 845-857-6027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number026393
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: