MEDICARE: SALLY MULNIX OT

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	5201001122	MI

General Provider Information

NPI Number	:	1699871970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY MULNIX OT

Provider Business Mailing Address
First Line	:	18680 VICARY RD
Second Line	:
City	:	CEMENT CITY
State	:	MI
Zip	:	49233-9602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 INDUSTRIAL DR
Second Line	:
City	:	TECUMSEH
State	:	MI
Zip	:	49286-9701
Country	:	US
Telephone Number	:	517-423-7722
Fax Number	:	517-423-1270

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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Directions to “ SALLY MULNIX OT” Practice Location

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