Provider Demographics
NPI:1629295985
Name:MCNULTY, HELENE MARIE (OT)
Entity Type:Individual
Prefix:MRS
First Name:HELENE
Middle Name:MARIE
Last Name:MCNULTY
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 1:1201 N 300 E
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-7846
Mailing Address - Country:US
Mailing Address - Phone:574-267-2423
Mailing Address - Fax:
Practice Address - Street 1:337 GRACE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WINONA LAKE
Practice Address - State:IN
Practice Address - Zip Code:46590-5774
Practice Address - Country:US
Practice Address - Phone:574-372-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001072A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist