MEDICARE: JENNIFER VANETTEN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1225806789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER VANETTEN OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 1149
Second Line	:
City	:	MORAVIA
State	:	NY
Zip	:	13118-1149
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2384 STATE ROUTE 34B
Second Line	:
City	:	AURORA
State	:	NY
Zip	:	13026-9743
Country	:	US
Telephone Number	:	315-364-7111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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Directions to “ JENNIFER VANETTEN OTR/L” Practice Location

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