Basic Information
| Provider Information | |||||||||
| NPI: | 1750932745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRUET | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S PINE ISLAND RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544736344 | ||||||||
| FaxNumber: | 9544529518 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 S PINE ISLAND RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544736344 | ||||||||
| FaxNumber: | 9544529518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2019 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT20320 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.