Provider Demographics
NPI:1154721926
Name:TOMASETTI, MA. CONCEPCION
Entity type:Individual
Prefix:
First Name:MA. CONCEPCION
Middle Name:
Last Name:TOMASETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LYNN PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-1049
Mailing Address - Country:US
Mailing Address - Phone:203-798-9766
Mailing Address - Fax:
Practice Address - Street 1:34 LYNN PL
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-1049
Practice Address - Country:US
Practice Address - Phone:203-798-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002304225X00000X
NY006425-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist