MEDICARE: MRS. KRISTIE ANN MCMULLEN MS OTR/L CLT PFP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	06293	MD

General Provider Information

NPI Number	:	1841564119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIE ANN MCMULLEN MS OTR/L CLT PFP

Provider Business Mailing Address
First Line	:	1812 BALTIMORE BLVD STE G
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-7144
Country	:	US
Telephone Number	:	410-848-6824
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 BALTIMORE BLVD STE G
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-7144
Country	:	US
Telephone Number	:	410-848-6824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	06/12/2014

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