Provider Demographics
NPI:1033473871
Name:MULLENHOTALING, KATHLEEN JOAN (MS SPECIAL ED)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JOAN
Last Name:MULLENHOTALING
Suffix:
Gender:F
Credentials:MS SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 3RD PL
Mailing Address - Street 2:APT. 3L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4552
Mailing Address - Country:US
Mailing Address - Phone:917-650-1647
Mailing Address - Fax:718-624-5082
Practice Address - Street 1:123 3RD PL
Practice Address - Street 2:APT. 3L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4552
Practice Address - Country:US
Practice Address - Phone:917-650-1647
Practice Address - Fax:718-624-5082
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist