Provider Demographics
NPI:1588631352
Name:MULL, TINA H (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:H
Last Name:MULL
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 1:107 CAVALIER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0301
Mailing Address - Country:US
Mailing Address - Phone:910-509-7444
Mailing Address - Fax:
Practice Address - Street 1:16717 US HIGHWAY 17 N
Practice Address - Street 2:SUITE 206
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3088
Practice Address - Country:US
Practice Address - Phone:910-270-2070
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4375225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist