Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1772 | FL |
N | 225X00000X | Occupational Therapist | 46TR00030200 | NJ |
NPI | 1003167347 |
---|---|
Provider Name | Mrs. Laurie A. Bulus |
First Address | Palm Coast, FL 32137-8533 |
Second Address | Palm Coast, FL 32137-8533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2012 |
Last Update Date | 17/10/2019 |