| Bianca Petrocelli Otrl, Llc | |
|
11230 Alligator Trl Lake Worth FL 33449-5849 | |
| (732) 742-8918 | |
| Not Available |
| Full Name | Bianca Petrocelli Otrl, Llc |
|---|---|
| Speciality | Occupational Therapist |
| Location | 11230 Alligator Trl, Lake Worth, Florida |
| Authorized Official Name and Position | Bianca Petrocelli (OWNER) |
| Authorized Official Contact | 7327428918 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bianca Petrocelli Otrl, Llc 11230 Alligator Trl Lake Worth FL 33449-5849 Ph: (732) 742-8918 | Bianca Petrocelli Otrl, Llc 11230 Alligator Trl Lake Worth FL 33449-5849 Ph: (732) 742-8918 |
| NPI Number | 1154108314 |
|---|---|
| Provider Enumeration Date | 09/12/2023 |
| Last Update Date | 09/12/2023 |
| Medicare PECOS PAC ID | 0840646410 |
|---|---|
| Medicare Enrollment ID | O20231102001942 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154108314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 225X00000X | Occupational Therapist | (* (Not Available)) | Primary |
| Provider Name | Bianca R Petrocelli |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558007799 PECOS PAC ID: 0840670485 Enrollment ID: I20220629001505 |
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