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General NPI Number Information
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NPI Number | 1679141642
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Entity Type | Individual
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Provider Name | FERDINAND LAWRENCE PILPA BUOT III OTR/L
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Gender | Male
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 50 MARK WEST SPRINGS RD STE 101
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City | SANTA ROSA
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State | CA
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Zip | 95403-1461
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Country | US
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Telephone | 707-527-0183
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Fax |
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Provider Business Mailing Address
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Address Line | 1328 RANGE AVE UNIT 206
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City | SANTA ROSA
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State | CA
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Zip | 95401-7039
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Country | US
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Telephone | 707-536-7634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 18675
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License Number State | CA
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