Healthcare Provider Details

I. General information

NPI: 1164690087
Provider Name (Legal Business Name): NANCY TOMANELLI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9927 FIELDCREST DR
APISON TN
37302-7576
US

IV. Provider business mailing address

9927 FIELDCREST DR
APISON TN
37302-7576
US

V. Phone/Fax

Practice location:
  • Phone: 423-827-4835
  • Fax: 423-600-0156
Mailing address:
  • Phone: 423-827-4835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT0000002383
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1164690087
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: