Healthcare Provider Details

I. General information

NPI: 1639483076
Provider Name (Legal Business Name): JENNIFER JOY ZACCARIELLO O.T.R/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ASHLAND AVE E
STATEN ISLAND NY
10312-3903
US

IV. Provider business mailing address

15 ASHLAND AVE E
STATEN ISLAND NY
10312-3903
US

V. Phone/Fax

Practice location:
  • Phone: 718-984-4056
  • Fax:
Mailing address:
  • Phone: 718-984-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number016237
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: