Provider Demographics
NPI:1255518924
Name:SOMOANO, TANIA (OT)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:SOMOANO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7941 EAST DR
Mailing Address - Street 2:PH 1
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3310
Mailing Address - Country:US
Mailing Address - Phone:305-321-6081
Mailing Address - Fax:
Practice Address - Street 1:7941 EAST DR
Practice Address - Street 2:PH 1
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-3310
Practice Address - Country:US
Practice Address - Phone:305-321-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891640300Medicaid
FLU3765YMedicare PIN