Provider Demographics
NPI:1851626972
Name:BULUSU, SANGEETHA (OT)
Entity Type:Individual
Prefix:
First Name:SANGEETHA
Middle Name:
Last Name:BULUSU
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SANGEETHA
Other - Middle Name:ANANTH
Other - Last Name:PRABHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19428 NEWLANE PL
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-4611
Mailing Address - Country:US
Mailing Address - Phone:630-303-6319
Mailing Address - Fax:
Practice Address - Street 1:19428 NEWLANE PL
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-4611
Practice Address - Country:US
Practice Address - Phone:630-303-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007585225X00000X
FLOT15341225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand