Provider Demographics
NPI:1871078105
Name:CARACCIOLO, NANCY (OTR/L)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:CARACCIOLO
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 1:475 PARK AVE S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6901
Mailing Address - Country:US
Mailing Address - Phone:212-683-1988
Mailing Address - Fax:
Practice Address - Street 1:4013 AVENUE U BLDG SUITE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5117
Practice Address - Country:US
Practice Address - Phone:718-692-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0207951225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist