Healthcare Provider Details

I. General information

NPI: 1952821712
Provider Name (Legal Business Name): RAQUEL PAIGE VESCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MANOR DR
OSWEGO NY
13126-6495
US

IV. Provider business mailing address

306 LEONARD ST
SYRACUSE NY
13211-1465
US

V. Phone/Fax

Practice location:
  • Phone: 315-349-5300
  • Fax:
Mailing address:
  • Phone: 315-484-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberP06556
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: