Provider Demographics
NPI:1386804714
Name:MCNULTY, JILLIAN MARIE (OT)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:MARIE
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S COLTS NECK WAY
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-9798
Mailing Address - Country:US
Mailing Address - Phone:609-922-2687
Mailing Address - Fax:609-922-2687
Practice Address - Street 1:116 S COLTS NECK WAY
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-9798
Practice Address - Country:US
Practice Address - Phone:609-922-2687
Practice Address - Fax:609-922-2687
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009707225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist