Provider Demographics
NPI:1083898399
Name:OCCUPATIONAL THERAPY SOUTH
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:MULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTR/L, ITFS-P
Authorized Official - Phone:704-843-2020
Mailing Address - Street 1:3022 CHISHOLM CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7865
Mailing Address - Country:US
Mailing Address - Phone:704-843-2020
Mailing Address - Fax:
Practice Address - Street 1:3022 CHISHOLM CT
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7865
Practice Address - Country:US
Practice Address - Phone:704-843-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty