Provider Demographics
NPI:1558708933
Name:MCNULTY, SARAH (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 V ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2726
Mailing Address - Country:US
Mailing Address - Phone:360-379-3867
Mailing Address - Fax:
Practice Address - Street 1:91 W VALLEY RD
Practice Address - Street 2:
Practice Address - City:CHIMACUM
Practice Address - State:WA
Practice Address - Zip Code:98325-7731
Practice Address - Country:US
Practice Address - Phone:360-732-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist