MEDICARE: KRISTY N PUCCI OTR/L, ATP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC007156L	PA

General Provider Information

NPI Number	:	1346547205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY N PUCCI OTR/L, ATP

Provider Business Mailing Address
First Line	:	3502 SCOTTS LN
Second Line	:	SUITE 711
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1561
Country	:	US
Telephone Number	:	610-277-0388
Fax Number	:

Provider Business Practice Location Address
First Line	:	3502 SCOTTS LN
Second Line	:	SUITE 711
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1561
Country	:	US
Telephone Number	:	610-277-0388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	07/21/2016

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