Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1631 | SC |
N | 225XP0200X | Occupational Therapist - Pediatrics | 1631 | SC |
NPI | 1013146968 |
---|---|
Provider Name | Mrs. Darlene Marie Mcnulty |
First Address | Seneca, SC 29672-6973 |
Second Address | Seneca, SC 29678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2009 |
Last Update Date | 13/07/2009 |