Provider Demographics
NPI:1659823359
Name:MCMULLEN, MAUREEN (COTA)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 DREW CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-9456
Mailing Address - Country:US
Mailing Address - Phone:585-365-3994
Mailing Address - Fax:
Practice Address - Street 1:3049 DREW CIRCLE RD
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-9456
Practice Address - Country:US
Practice Address - Phone:585-365-3994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007894-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist