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General NPI Number Information
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NPI Number | 1821569062
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Entity Type | Individual
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Provider Name | MRS. TRACY ROMAINE VENDITUOLI
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Gender | Female
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 19 LA MONTANA CORTE
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City | SONOITA
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State | AZ
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Zip | 85637
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Country | US
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Telephone | 520-732-9371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 631
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City | SONOITA
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State | AZ
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Zip | 85637-0631
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Country | US
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Telephone | 520-732-9371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224ZL0004X
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Taxonomy Name | Low Vision Occupational Therapy Assistant
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License Number | 6810
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License Number State | AZ
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