Healthcare Provider Details

I. General information

NPI: 1912468752
Provider Name (Legal Business Name): LILLIAN TAYLOR MULLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 JENKINS MEMORIAL RD
WELLSTON OH
45692-9561
US

IV. Provider business mailing address

1264 S PENNSYLVANIA AVE
WELLSTON OH
45692-2324
US

V. Phone/Fax

Practice location:
  • Phone: 740-384-2119
  • Fax:
Mailing address:
  • Phone: 740-395-4712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA011002
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: