MEDICARE: TARA MARIE MARTELLO MS, OTRL

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	OC008357	PA
2	225XP0200X	Pediatric Occupational Therapist	46TR00316400	NJ
3	225X00000X	Occupational Therapist	OT21580	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891996021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA MARIE MARTELLO MS, OTRL

Provider Business Mailing Address
First Line	:	2900 SALERNO WAY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-7148
Country	:	US
Telephone Number	:	561-501-1983
Fax Number	:	561-270-6965

Provider Business Practice Location Address
First Line	:	2900 SALERNO WAY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-7148
Country	:	US
Telephone Number	:	561-501-1983
Fax Number	:	561-270-6965

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

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	06/03/2021

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