Provider Demographics
NPI:1750932745
Name:PRUET, EMILY KATHLEEN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHLEEN
Last Name:PRUET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:KATHLEEN
Other - Last Name:PRUET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9101 FRANKLIN SQUARE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3975
Mailing Address - Country:US
Mailing Address - Phone:443-777-6766
Mailing Address - Fax:443-777-6765
Practice Address - Street 1:600 S PINE ISLAND RD STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3179
Practice Address - Country:US
Practice Address - Phone:954-473-6344
Practice Address - Fax:954-452-9518
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09199225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist