Individual
BRIELLE KAYLA MULLIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1405 ROUTE 18 STE 203, OLD BRIDGE, NJ 08857-3777
(732) 967-0900
Mailing address
PO BOX 508, ROOSEVELT, NJ 08555-0508
(609) 578-7403
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR01082800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46TR01082800
OT LICENSE
NJ
Enumeration date
09/23/2022
Last updated
09/23/2022
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