MEDICARE: ENZA VANESSA SALLUSTIO 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	456357	NY
2	225X00000X	Occupational Therapist	026170	NY

General Provider Information

NPI Number	:	1477125334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENZA VANESSA SALLUSTIO OTR/L

Provider Business Mailing Address
First Line	:	476 AVENUE Y
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6050
Country	:	US
Telephone Number	:	917-535-1460
Fax Number	:

Provider Business Practice Location Address
First Line	:	476 AVENUE Y
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6050
Country	:	US
Telephone Number	:	917-535-1460
Fax Number	:

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

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	10/29/2021

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Directions to “ ENZA VANESSA SALLUSTIO OTR/L” Practice Location

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