Provider Demographics
NPI:1215074356
Name:MCNULTY, SUSAN (MA, OTRL)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:MA, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2363
Mailing Address - Country:US
Mailing Address - Phone:310-357-9936
Mailing Address - Fax:
Practice Address - Street 1:812 W TOWN AND COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4712
Practice Address - Country:US
Practice Address - Phone:714-547-6494
Practice Address - Fax:714-550-5285
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 7925225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist