Provider Demographics
NPI:1962551614
Name:FORNUTO, JULIE LYNN (OTRL)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNN
Last Name:FORNUTO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S POND DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-7970
Mailing Address - Country:US
Mailing Address - Phone:401-651-4068
Mailing Address - Fax:
Practice Address - Street 1:1160 POST RD
Practice Address - Street 2:SUITE 8
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3265
Practice Address - Country:US
Practice Address - Phone:401-941-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00391225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics