Provider Demographics
NPI:1043391071
Name:TRANQUILLI, MICHAEL (MA, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:TRANQUILLI
Suffix:
Gender:M
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WEXFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1517
Mailing Address - Country:US
Mailing Address - Phone:973-494-3499
Mailing Address - Fax:973-443-4111
Practice Address - Street 1:4 WEXFORD RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1517
Practice Address - Country:US
Practice Address - Phone:973-494-3499
Practice Address - Fax:973-443-4111
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00193700225XN1300X, 225XE1200X, 225XH1300X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
106685ZA5EMedicare PIN