Provider Demographics
NPI:1124404660
Name:MULCAHY, KRISTINA (MOT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1094
Mailing Address - Country:US
Mailing Address - Phone:856-513-2468
Mailing Address - Fax:609-228-0678
Practice Address - Street 1:401 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1094
Practice Address - Country:US
Practice Address - Phone:856-513-2468
Practice Address - Fax:609-228-0678
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00698300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist