Provider Demographics
NPI:1043685571
Name:FITZ-JAMES, VIVIAN ELAINE (COTA)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:ELAINE
Last Name:FITZ-JAMES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1017
Mailing Address - Country:US
Mailing Address - Phone:518-842-3487
Mailing Address - Fax:
Practice Address - Street 1:43 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-5635
Practice Address - Country:US
Practice Address - Phone:518-954-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003765-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant