Provider Demographics
NPI:1962614040
Name:PULLARA, MARTINE LOUISE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:MARTINE
Middle Name:LOUISE
Last Name:PULLARA
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 1:10467 N BELL RD
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-9415
Mailing Address - Country:US
Mailing Address - Phone:815-467-4155
Mailing Address - Fax:
Practice Address - Street 1:3401 HENNEPIN DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-1080
Practice Address - Country:US
Practice Address - Phone:815-436-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist