MEDICARE: JOAN ELAINE MCMULLEN OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417149535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN ELAINE MCMULLEN OTR

Provider Business Mailing Address
First Line	:	3111 S JASMINE WAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7627
Country	:	US
Telephone Number	:	303-757-0546
Fax Number	:	303-757-0546

Provider Business Practice Location Address
First Line	:	3111 S JASMINE WAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7627
Country	:	US
Telephone Number	:	303-757-0546
Fax Number	:	303-757-0546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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