Provider Demographics
NPI:1336451996
Name:RULITE, MYLENE RUTH T (OT)
Entity Type:Individual
Prefix:
First Name:MYLENE RUTH
Middle Name:T
Last Name:RULITE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 TINA LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5024
Mailing Address - Country:US
Mailing Address - Phone:407-451-8330
Mailing Address - Fax:
Practice Address - Street 1:1528 TINA LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5024
Practice Address - Country:US
Practice Address - Phone:407-451-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-11
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2375225X00000X
TX113159225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist