Provider Demographics
NPI:1306037130
Name:TOMASELLO, MARY A (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:TOMASELLO
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 UNIVERSITY PKWY
Mailing Address - Street 2:BUILDING #3 SUITE #218
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2809
Mailing Address - Country:US
Mailing Address - Phone:941-359-9555
Mailing Address - Fax:941-359-1555
Practice Address - Street 1:2415 UNIVERSITY PKWY
Practice Address - Street 2:BUILDING #3 SUITE #218
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2809
Practice Address - Country:US
Practice Address - Phone:941-359-9555
Practice Address - Fax:941-359-1555
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12835225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000385100Medicaid
FL892350700Medicaid