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General NPI Number Information
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NPI Number | 1265074330
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Entity Type | Individual
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Provider Name | ALYSE MARIE MULVANEY
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Gender | Female
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 34 WHITE BRIDGE RD
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City | NASHVILLE
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State | TN
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Zip | 37205-1473
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Country | US
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Telephone | 615-353-6181
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Fax |
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Provider Business Mailing Address
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Address Line | 712 CARMEL AVE
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City | MADISON
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State | TN
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Zip | 37115-4110
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Country | US
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Telephone | 407-712-5615
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT0000006250
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License Number State | TN
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