Provider Demographics
NPI:1013778919
Name:ANNUNZIATA, TIA
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:ANNUNZIATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2112
Mailing Address - Country:US
Mailing Address - Phone:781-219-8430
Mailing Address - Fax:
Practice Address - Street 1:6264 FERRIS SQ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3204
Practice Address - Country:US
Practice Address - Phone:619-940-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics