Provider Demographics
NPI:1568269694
Name:BULLARD, FAITH REBECCA (COTA)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:REBECCA
Last Name:BULLARD
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-1500
Mailing Address - Country:US
Mailing Address - Phone:315-363-3389
Mailing Address - Fax:315-363-9286
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-1648
Practice Address - Country:US
Practice Address - Phone:315-363-3389
Practice Address - Fax:315-363-9286
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11680224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant