Provider Demographics
NPI:1285045856
Name:HAUTALA, TONYA JEAN (ATC,L EMT)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:JEAN
Last Name:HAUTALA
Suffix:
Gender:F
Credentials:ATC,L EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 KEMBLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545
Mailing Address - Country:US
Mailing Address - Phone:508-842-3820
Mailing Address - Fax:
Practice Address - Street 1:10 KEMBLE DR
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-1690
Practice Address - Country:US
Practice Address - Phone:508-842-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer