Provider Demographics
NPI:1275844037
Name:MASTROIANNI, TERESA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:MASTROIANNI
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 1:130 BROOKLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4300
Mailing Address - Country:US
Mailing Address - Phone:315-533-1150
Mailing Address - Fax:
Practice Address - Street 1:130 BROOKLEY RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4300
Practice Address - Country:US
Practice Address - Phone:315-533-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011738225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist