MEDICARE: FAITH NOELLE FUCETOLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	7916	SC

General Provider Information

NPI Number	:	1114865227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH NOELLE FUCETOLA

Provider Business Mailing Address
First Line	:	360 STONEWALL CT APT 4204
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-7990
Country	:	US
Telephone Number	:	570-369-7408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 QUEENSBOROUGH BLVD STE 104
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-5431
Country	:	US
Telephone Number	:	843-216-0290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	05/27/2026

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Directions to “ FAITH NOELLE FUCETOLA ” Practice Location

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