Provider Demographics
NPI:1609110592
Name:MULL, ALICIA EVELYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:EVELYN
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 1:60 KAHDENA RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-3525
Mailing Address - Country:US
Mailing Address - Phone:973-906-6668
Mailing Address - Fax:
Practice Address - Street 1:6551 PARK OF COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-8218
Practice Address - Country:US
Practice Address - Phone:800-347-2264
Practice Address - Fax:561-998-8533
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011599225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist