Provider Demographics
NPI:1003189937
Name:DOMENICO TASSO, TONYA GAIL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:GAIL
Last Name:DOMENICO TASSO
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 1:38 PARK ST
Mailing Address - Street 2:UNIT 7C
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1794
Mailing Address - Country:US
Mailing Address - Phone:973-295-2752
Mailing Address - Fax:
Practice Address - Street 1:4 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-9368
Practice Address - Country:US
Practice Address - Phone:973-295-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00555200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist