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General NPI Number Information
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NPI Number | 1932644358
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Entity Type | Individual
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Provider Name | MONICA TOMASELLO
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Gender | Female
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 68 ORCHARD ST
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City | WILLIAMS BAY
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State | WI
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Zip | 53191-9708
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Country | US
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Telephone | 262-203-4963
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Fax |
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Provider Business Mailing Address
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Address Line | 484 FOX LN
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City | WALWORTH
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State | WI
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Zip | 53184-9792
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Country | US
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Telephone | 262-203-4963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2602-26
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 940
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License Number State | SC
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