Provider Demographics
NPI:1841564119
Name:MCMULLEN, KRISTIE ANN (MS OTR/L CLT PFP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:ANN
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:MS OTR/L CLT PFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 BALTIMORE BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7144
Mailing Address - Country:US
Mailing Address - Phone:410-848-6824
Mailing Address - Fax:
Practice Address - Street 1:1812 BALTIMORE BLVD STE G
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7144
Practice Address - Country:US
Practice Address - Phone:410-848-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06293225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation