Provider Demographics
NPI:1174680417
Name:MULLEN-COLKITT, LINDA A (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:A
Last Name:MULLEN-COLKITT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:A
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 MAYFAIR LN
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-4712
Mailing Address - Country:US
Mailing Address - Phone:716-694-9351
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3225
Practice Address - Fax:716-898-3259
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002876-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist