Provider Demographics
NPI:1891949285
Name:MULLIN, ISABEL
Entity Type:Individual
Prefix:MRS
First Name:ISABEL
Middle Name:
Last Name:MULLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ISABEL
Other - Middle Name:MARGARET
Other - Last Name:WIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA OT
Mailing Address - Street 1:1405 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5218
Mailing Address - Country:US
Mailing Address - Phone:310-546-5030
Mailing Address - Fax:310-546-5030
Practice Address - Street 1:1405 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5218
Practice Address - Country:US
Practice Address - Phone:310-546-5030
Practice Address - Fax:310-546-5030
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3763225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology