MEDICARE: MRS. HELENE MARIE MCNULTY O.T.

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	31001072A	IN

General Provider Information

NPI Number	:	1629295985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HELENE MARIE MCNULTY O.T.

Provider Business Mailing Address
First Line	:	1201 N 300 E
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46582-7846
Country	:	US
Telephone Number	:	574-267-2423
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 GRACE VILLAGE DR
Second Line	:
City	:	WINONA LAKE
State	:	IN
Zip	:	46590-5774
Country	:	US
Telephone Number	:	574-372-6372
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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