Healthcare Provider Details

I. General information

NPI: 1659009140
Provider Name (Legal Business Name): MELISSA ANN TOFFOLONI OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MAPLE ST
PLYMPTON MA
02367-1204
US

IV. Provider business mailing address

26 MAPLE ST
PLYMPTON MA
02367-1204
US

V. Phone/Fax

Practice location:
  • Phone: 781-264-3351
  • Fax:
Mailing address:
  • Phone: 781-264-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12390
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: