Provider Demographics
NPI:1174221733
Name:VIZIOLI, MOLLYANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:MOLLYANNE
Middle Name:
Last Name:VIZIOLI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 GRASSLANDS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1520
Mailing Address - Country:US
Mailing Address - Phone:914-593-0593
Mailing Address - Fax:
Practice Address - Street 1:503 GRASSLANDS RD STE 101
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1520
Practice Address - Country:US
Practice Address - Phone:914-593-0593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025295-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist