Provider Demographics
NPI:1124838677
Name:MCNULTY, COLIN (OTD, OTR/L; CPT)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:OTD, OTR/L; CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PRICE AVE UNIT 412
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-0049
Mailing Address - Country:US
Mailing Address - Phone:330-256-3380
Mailing Address - Fax:
Practice Address - Street 1:4400 MARKETING PL STE B
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9308
Practice Address - Country:US
Practice Address - Phone:614-492-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT013064225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist