MEDICARE: CALISTA GAETANA TOMASETTI MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT009313

General Provider Information

NPI Number	:	1376370973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALISTA GAETANA TOMASETTI MS

Provider Business Mailing Address
First Line	:	33 HIGH ST
Second Line	:
City	:	SAYVILLE
State	:	NY
Zip	:	11782-1333
Country	:	US
Telephone Number	:	631-379-9320
Fax Number	:

Provider Business Practice Location Address
First Line	:	4875 HOG MOUNTAIN RD STE AB
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3476
Country	:	US
Telephone Number	:	678-960-3063
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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