Provider Demographics
NPI:1851522809
Name:MCNULTY, KATHLEEN (OT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
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 1:2600 BARRACKS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2121
Mailing Address - Country:US
Mailing Address - Phone:434-996-8443
Mailing Address - Fax:434-293-4520
Practice Address - Street 1:9704CANDACECOURT
Practice Address - Street 2:
Practice Address - City:GLENALLEN
Practice Address - State:UT
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:434-996-8443
Practice Address - Fax:434-293-4520
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist