Provider Demographics
NPI:1134402118
Name:TUTTLE, REBECCA ROSE BULEN (OTR/L, PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROSE BULEN
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:OTR/L, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5799
Mailing Address - Country:US
Mailing Address - Phone:904-829-3411
Mailing Address - Fax:904-829-3412
Practice Address - Street 1:1 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5799
Practice Address - Country:US
Practice Address - Phone:904-829-3411
Practice Address - Fax:904-829-3412
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14243225X00000X
FLPT26871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist