Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 46TR00083100 | NJ |
NPI | 1740942887 |
---|---|
Provider Name | Michelle Tarantino |
First Address | Bayville, NJ 08721-3530 |
Second Address | Bayville, NJ 08721-3530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2021 |
Last Update Date | 06/10/2021 |