Provider Demographics
NPI:1891996021
Name:MARTELLO, TARA MARIE (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:MARTELLO
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SALERNO WAY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7148
Mailing Address - Country:US
Mailing Address - Phone:561-501-1983
Mailing Address - Fax:561-270-6965
Practice Address - Street 1:2900 SALERNO WAY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-7148
Practice Address - Country:US
Practice Address - Phone:561-501-1983
Practice Address - Fax:561-270-6965
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008357225XP0200X
NJ46TR00316400225XP0200X
FLOT21580225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109803400Medicaid