Healthcare Provider Details

I. General information

NPI: 1356435382
Provider Name (Legal Business Name): ANTONIA LLULL MOT,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MAITLAND AVE STE 1150
ALTAMONTE SPRINGS FL
32701-6306
US

IV. Provider business mailing address

505 MAITLAND AVE STE 1150
ALTAMONTE SPRINGS FL
32701-6306
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-1617
  • Fax: 321-972-1947
Mailing address:
  • Phone: 321-972-1617
  • Fax: 321-972-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT8396
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number019956-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00716600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: