Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1010 | WY |
NPI | 1073041646 |
---|---|
Provider Name | Lauren Mullaney |
First Address | Gillette, WY 82716-3582 |
Second Address | Gillette, WY 82716-3582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2017 |
Last Update Date | 26/05/2017 |