Provider Demographics
NPI:1154666220
Name:PULCINO, MARIE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:PULCINO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 JUPITER LAKES BLVD APT 2113A
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7109
Mailing Address - Country:US
Mailing Address - Phone:561-801-2121
Mailing Address - Fax:
Practice Address - Street 1:431 JUPITER LAKES BLVD APT 2113A
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7109
Practice Address - Country:US
Practice Address - Phone:561-801-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA4062224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant