Provider Demographics
NPI:1376370973
Name:TOMASETTI, CALISTA GAETANA (MS)
Entity type:Individual
Prefix:
First Name:CALISTA
Middle Name:GAETANA
Last Name:TOMASETTI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1333
Mailing Address - Country:US
Mailing Address - Phone:631-379-9320
Mailing Address - Fax:
Practice Address - Street 1:4875 HOG MOUNTAIN RD STE AB
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3476
Practice Address - Country:US
Practice Address - Phone:678-960-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OT009313225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics