Provider Demographics
NPI:1770605602
Name:PULLARA, HEIDI LYNN (MS, OTRL)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:PULLARA
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MANOR SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9500
Mailing Address - Country:US
Mailing Address - Phone:410-592-2572
Mailing Address - Fax:
Practice Address - Street 1:7700 YORK RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7513
Practice Address - Country:US
Practice Address - Phone:410-821-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04750225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist