Provider Demographics
NPI:1538665633
Name:MCMULLIN, STARLA LINDA (LMT)
Entity Type:Individual
Prefix:
First Name:STARLA
Middle Name:LINDA
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 NW ELM AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7021
Mailing Address - Country:US
Mailing Address - Phone:541-815-0883
Mailing Address - Fax:
Practice Address - Street 1:716 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2648
Practice Address - Country:US
Practice Address - Phone:541-805-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14502225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty