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General NPI Number Information
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NPI Number | 1174046510
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Entity Type | Individual
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Provider Name | MEGAN CATHERINE MULLINS LMT
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 2311 N 9TH ST SUITE 101
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City | BROKEN ARROW
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State | OK
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Zip | 74012
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Country | US
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Telephone | 918-994-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S STATE ST APT B
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City | WAGONER
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State | OK
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Zip | 74467-5205
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Country | US
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Telephone | 918-350-8244
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 173361
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License Number State | OK
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