Provider Demographics
NPI:1679141642
Name:BUOT, FERDINAND LAWRENCE PILPA III (OTR/L)
Entity type:Individual
Prefix:MR
First Name:FERDINAND LAWRENCE
Middle Name:PILPA
Last Name:BUOT
Suffix:III
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 1:1328 RANGE AVE UNIT 206
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-7039
Mailing Address - Country:US
Mailing Address - Phone:707-536-7634
Mailing Address - Fax:
Practice Address - Street 1:50 MARK WEST SPRINGS RD STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1461
Practice Address - Country:US
Practice Address - Phone:707-527-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18675225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics