Provider Demographics
NPI:1902240633
Name:TOMASIELLO, MARIA ANN
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANN
Last Name:TOMASIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ORTNER
Other - Middle Name:ANN
Other - Last Name:MARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9540 HIBISCUS AVE
Mailing Address - Street 2:
Mailing Address - City:MICCO
Mailing Address - State:FL
Mailing Address - Zip Code:32976-3006
Mailing Address - Country:US
Mailing Address - Phone:772-567-8585
Mailing Address - Fax:
Practice Address - Street 1:2965 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3097
Practice Address - Country:US
Practice Address - Phone:772-567-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12658224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant