Provider Demographics
NPI:1962731489
Name:PUCHERO, MARNI SUSTENTO (OTR/L)
Entity type:Individual
Prefix:MR
First Name:MARNI
Middle Name:SUSTENTO
Last Name:PUCHERO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 GREENBORO DR
Mailing Address - Street 2:APARTMENT #2
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1403
Mailing Address - Country:US
Mailing Address - Phone:321-327-3791
Mailing Address - Fax:
Practice Address - Street 1:7365 ORCHESTRA LN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2616
Practice Address - Country:US
Practice Address - Phone:321-610-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13876225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist