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General NPI Number Information
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NPI Number | 1154108314
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Entity Type | Organization
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Legal Business Name | BIANCA PETROCELLI OTRL, LLC
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 11230 ALLIGATOR TRL
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City | LAKE WORTH
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State | FL
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Zip | 33449-5849
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Country | US
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Telephone | 732-742-8918
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Fax |
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Provider Business Mailing Address
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Address Line | 11230 ALLIGATOR TRL
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City | LAKE WORTH
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State | FL
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Zip | 33449-5849
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Country | US
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Telephone | 732-742-8918
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BIANCA PETROCELLI
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Credential | OTR/L
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Telephone | 732-742-8918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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