Provider Demographics
NPI:1831471309
Name:TARANTELLI, NICHOLAS JOHN (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN
Last Name:TARANTELLI
Suffix:
Gender:M
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 1:341 SWEET HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13807-1172
Mailing Address - Country:US
Mailing Address - Phone:607-293-8898
Mailing Address - Fax:
Practice Address - Street 1:341 SWEET HILL RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NY
Practice Address - Zip Code:13807-1172
Practice Address - Country:US
Practice Address - Phone:607-293-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006899-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics