Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00555200 | NJ |
NPI | 1003189937 |
---|---|
Provider Name | Mrs. Tonya Gail Domenico Tasso |
First Address | Florham Park, NJ 07932-1794 |
Second Address | Morristown, NJ 07960-9368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2012 |
Last Update Date | 23/02/2012 |