Provider Demographics
NPI:1427174150
Name:OCCUPATIONAL THERAPY SOUTH
Entity type:Organization
Organization Name:OCCUPATIONAL THERAPY SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, O.T. SOUTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:MULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTRL
Authorized Official - Phone:704-843-2020
Mailing Address - Street 1:3022 CHISHOLM CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7865
Mailing Address - Country:US
Mailing Address - Phone:704-843-2020
Mailing Address - Fax:
Practice Address - Street 1:3022 CHISHOLM CT
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7865
Practice Address - Country:US
Practice Address - Phone:704-843-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1649358862OtherINDIV. NPI LAUREN MULLAN
NC7301928Medicaid