Provider Demographics
NPI:1386884096
Name:TORNELLO, CAROL (OTL)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:TORNELLO
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 OVIS PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3717
Mailing Address - Country:US
Mailing Address - Phone:718-979-8211
Mailing Address - Fax:718-979-8464
Practice Address - Street 1:27 OVIS PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3717
Practice Address - Country:US
Practice Address - Phone:718-979-8211
Practice Address - Fax:718-979-8464
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000783-1225X00000X, 225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation