Provider Demographics
NPI:1336763564
Name:BULLARD, MARK (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BULLARD
Suffix:
Gender:M
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-2007
Mailing Address - Country:US
Mailing Address - Phone:603-332-2848
Mailing Address - Fax:
Practice Address - Street 1:105 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-2007
Practice Address - Country:US
Practice Address - Phone:603-332-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0458224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant