Provider Demographics
NPI:1659463172
Name:DERR MULLINS, GRETCHEN GAIL (MSAT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:GAIL
Last Name:DERR MULLINS
Suffix:
Gender:F
Credentials:MSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14697 WOODS LN
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64084-9019
Mailing Address - Country:US
Mailing Address - Phone:816-645-5227
Mailing Address - Fax:
Practice Address - Street 1:3515 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2537
Practice Address - Country:US
Practice Address - Phone:816-753-5144
Practice Address - Fax:816-753-0804
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist