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3872 Sheridan Street, Hollywood, FL 33021 | |
(954) 987-7077 | |
(954) 987-7044 |
Full Name | |
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Type | Facility |
Speciality | Occupational Therapist |
Location | 3872 Sheridan Street, Hollywood, Florida |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1356411748 | NPI | - | NPPES |
X1398 | Other | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
171100000X | Acupuncturist | AP1162 (Florida) | Primary |
225X00000X | Occupational Therapist | OT931 (Florida) | Primary |
225X00000X | Occupational Therapist | OT1273 (Florida) | Primary |
Provider Name | Thomas Patullo |
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Provider Type | Practitioner - Occupational Therapist In Private Practice |
Provider Identifiers | NPI Number: 1831262146 PECOS PAC ID: 9335328194 Enrollment ID: I20111116000362 |
Mailing Address | Practice Location Address |
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3872 Sheridan Street, Hollywood, FL 33021 Ph: (954) 987-7077 | 3872 Sheridan Street, Hollywood, FL 33021 Ph: (954) 987-7077 |