Healthcare Provider Details

I. General information

NPI: 1346445723
Provider Name (Legal Business Name): SHELLEY ELIZABETH MULLIGAN PHD., OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LIBRARY WAY
DURHAM NH
03824-3520
US

IV. Provider business mailing address

4 ROCKY LN
DURHAM NH
03824-1947
US

V. Phone/Fax

Practice location:
  • Phone: 603-862-3528
  • Fax:
Mailing address:
  • Phone: 603-862-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1068
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: