Individual
MR. CARL ANTHONY PETITTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT/L
Contact information
Practice address
22567 SUMMIT DR BLDG 2, WATERTOWN, NY 13601-7210
(315) 779-6784
(315) 779-6799
Mailing address
22567 SUMMIT DR BLDG 2, WATERTOWN, NY 13601-7210
(315) 779-6784
(315) 779-6799
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0107001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02163660
GROUP MEDICAID
NY
05
—
02562729
—
NY
01
—
BA0113
GR MEDICARE
—
Enumeration date
12/22/2005
Last updated
07/06/2022
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