MEDICARE: SUSAN ELIZABETH MULLINS OTR/L

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	225X00000X	Occupational Therapist	OT2172	FL
2	225X00000X	Occupational Therapist	OT000704	GA

General Provider Information

NPI Number	:	1417959388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ELIZABETH MULLINS OTR/L

Provider Business Mailing Address
First Line	:	348 8TH ST
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5436
Country	:	US
Telephone Number	:	904-247-4839
Fax Number	:	904-241-4038

Provider Business Practice Location Address
First Line	:	348 8TH ST
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5436
Country	:	US
Telephone Number	:	904-247-4839
Fax Number	:	904-241-4038

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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