Provider Demographics
NPI:1003079161
Name:MCNULTYL, LILLIAN MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:MARIE
Last Name:MCNULTYL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MILLRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3114
Mailing Address - Country:US
Mailing Address - Phone:440-995-7300
Mailing Address - Fax:
Practice Address - Street 1:4533 PARK AVE
Practice Address - Street 2:PARKHAVEN HOME
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6930
Practice Address - Country:US
Practice Address - Phone:888-796-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002628225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation