Provider Demographics
NPI:1417149535
Name:MCMULLEN, JOAN ELAINE (OTR)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ELAINE
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 S JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7627
Mailing Address - Country:US
Mailing Address - Phone:303-757-0546
Mailing Address - Fax:303-757-0546
Practice Address - Street 1:3111 S JASMINE WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7627
Practice Address - Country:US
Practice Address - Phone:303-757-0546
Practice Address - Fax:303-757-0546
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO127225Medicaid