Healthcare Provider Details

I. General information

NPI: 1144071671
Provider Name (Legal Business Name): GINA A TARTARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KING STREET
NORTHAMPTON MA
01060-3234
US

IV. Provider business mailing address

131 KING STREET
NORTHAMPTON MA
01060-3234
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-8717
  • Fax:
Mailing address:
  • Phone: 413-665-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11150
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: