Provider Demographics
NPI:1437488079
Name:MULL, BETH A (OT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:MULL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2134
Mailing Address - Country:US
Mailing Address - Phone:906-337-6591
Mailing Address - Fax:906-337-6597
Practice Address - Street 1:960 RAZORBACK DR
Practice Address - Street 2:SUITE 3
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2830
Practice Address - Country:US
Practice Address - Phone:906-482-8201
Practice Address - Fax:906-482-2771
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1625164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist