Healthcare Provider Details

I. General information

NPI: 1780703553
Provider Name (Legal Business Name): LULA MARIE CAPUCHINO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 MARCONI AVE
SACRAMENTO CA
95821-5309
US

IV. Provider business mailing address

PO BOX 6268
FOLSOM CA
95763-6268
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-1300
  • Fax:
Mailing address:
  • Phone: 916-481-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberOT2084
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOT2084
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberOT2084
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT2084
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT2084
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License NumberOT2084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: