Healthcare Provider Details

I. General information

NPI: 1710025564
Provider Name (Legal Business Name): CHRISTINE ALISA MULLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MUNCIE RD
WEST BABYLON NY
11704-8223
US

IV. Provider business mailing address

77 MUNCIE RD
WEST BABYLON NY
11704-8223
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-1924
  • Fax:
Mailing address:
  • Phone: 631-321-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008612
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number008612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: