Provider Demographics
NPI:1245832138
Name:TIANO, VINCENT (DROT, OTR/L)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:TIANO
Suffix:
Gender:M
Credentials:DROT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 JOHNSON FARM LN APT 303
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9057
Mailing Address - Country:US
Mailing Address - Phone:215-595-3165
Mailing Address - Fax:
Practice Address - Street 1:2202 W OAK AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7222
Practice Address - Country:US
Practice Address - Phone:813-754-3761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist