Provider Demographics
NPI:1053732826
Name:TOSCANO, DOMINIC JOSEPH (OTR)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:JOSEPH
Last Name:TOSCANO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1803
Mailing Address - Country:US
Mailing Address - Phone:317-431-6456
Mailing Address - Fax:
Practice Address - Street 1:3177 MERIDIAN PARKE DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-9629
Practice Address - Country:US
Practice Address - Phone:317-882-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-22
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005267A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist