Provider Demographics
NPI:1306561212
Name:BOCK MULLOOLY, KARIN JOHANA
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:JOHANA
Last Name:BOCK MULLOOLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 HIGHWAY 274 # 134
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-6045
Mailing Address - Country:US
Mailing Address - Phone:803-631-5300
Mailing Address - Fax:
Practice Address - Street 1:1090 HAY ROW RD
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-9629
Practice Address - Country:US
Practice Address - Phone:516-316-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach