Provider Demographics
NPI:1215304621
Name:PUCILLO, ABBY FRANCIS (MSOTR/L)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:FRANCIS
Last Name:PUCILLO
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 15TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-4437
Mailing Address - Country:US
Mailing Address - Phone:209-559-4002
Mailing Address - Fax:
Practice Address - Street 1:452 GRAND ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2062
Practice Address - Country:US
Practice Address - Phone:209-559-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA16159225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No171M00000XOther Service ProvidersCase Manager/Care Coordinator