Provider Demographics
NPI:1871704494
Name:CELLUCCI, DEBRA SUSAN (OTR)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SUSAN
Last Name:CELLUCCI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 GREENERY CT
Mailing Address - Street 2:#202
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14517 BRUCE B DOWNS BLVD
Practice Address - Street 2:ST #201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2755
Practice Address - Country:US
Practice Address - Phone:813-228-2761
Practice Address - Fax:813-225-7048
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2995225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist