Provider Demographics
NPI:1407088909
Name:MCMULLEN, RANDY W JR (MS)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:W
Last Name:MCMULLEN
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-4160
Mailing Address - Country:US
Mailing Address - Phone:207-474-9686
Mailing Address - Fax:
Practice Address - Street 1:23 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-4160
Practice Address - Country:US
Practice Address - Phone:207-474-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist