MEDICARE: LORRI S PAULUCCI OTR/L

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	225XP0200X	Pediatric Occupational Therapist	009195-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	009195-1	OTHER	NY	SELF-EMPLOYED
2	225XPO200X	OTHER	NY	SELF-EMPLOYED

General Provider Information

NPI Number	:	1457506818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRI S PAULUCCI OTR/L

Provider Business Mailing Address
First Line	:	288 11TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3911
Country	:	US
Telephone Number	:	917-403-3324
Fax Number	:

Provider Business Practice Location Address
First Line	:	288 11TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3911
Country	:	US
Telephone Number	:	718-499-0193
Fax Number	:

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

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	12/03/2008

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