Provider Demographics
NPI:1346547205
Name:PUCCI, KRISTY N (OTR/L, ATP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:N
Last Name:PUCCI
Suffix:
Gender:F
Credentials:OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 SCOTTS LN
Mailing Address - Street 2:SUITE 711
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1561
Mailing Address - Country:US
Mailing Address - Phone:610-277-0388
Mailing Address - Fax:
Practice Address - Street 1:3502 SCOTTS LN
Practice Address - Street 2:SUITE 711
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1561
Practice Address - Country:US
Practice Address - Phone:610-277-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007156L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist