MEDICARE: KIRSTIE TULLIS OTR

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		FL

General Provider Information

NPI Number	:	1619498466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTIE TULLIS OTR

Provider Business Mailing Address
First Line	:	1963 BURLINGTON AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-8030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1963 BURLINGTON AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-8030
Country	:	US
Telephone Number	:	832-794-1502
Fax Number	:

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

Provider Enumeration Date	:	07/02/2017
Last Update Date	:	07/02/2017

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Directions to “ KIRSTIE TULLIS OTR” Practice Location

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