Healthcare Provider Details

I. General information

NPI: 1215304621
Provider Name (Legal Business Name): ABBY FRANCIS PUCILLO MSOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 GRAND ST
REDWOOD CITY CA
94062-2062
US

IV. Provider business mailing address

1027 15TH AVE UNIT B
REDWOOD CITY CA
94063-4437
US

V. Phone/Fax

Practice location:
  • Phone: 209-559-4002
  • Fax:
Mailing address:
  • Phone: 209-559-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number16159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: