Healthcare Provider Details

I. General information

NPI: 1720329899
Provider Name (Legal Business Name): TONI MASTRODONATO WHITE OT, MOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI ANN MASTRODONATO COTA

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WEST 134TH PLACE
CUT OFF LA
70345
US

IV. Provider business mailing address

174 W 138TH ST
CUT OFF LA
70345-4131
US

V. Phone/Fax

Practice location:
  • Phone: 985-632-7919
  • Fax: 985-632-3581
Mailing address:
  • Phone: 985-691-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 200359
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number311473
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: