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General NPI Number Information
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NPI Number | 1003079161
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Entity Type | Individual
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Provider Name | LILLIAN MARIE MCNULTYL OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 4533 PARK AVE PARKHAVEN HOME
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City | ASHTABULA
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State | OH
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Zip | 44004-6930
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Country | US
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Telephone | 888-796-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 950 MILLRIDGE RD
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City | HIGHLAND HEIGHTS
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State | OH
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Zip | 44143-3114
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Country | US
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Telephone | 440-995-7300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 002628
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License Number State | OH
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