Individual
MR. MARK MULLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
3221 RYAN ST, SUITE D, LAKE CHARLES, LA 70601
(337) 439-3344
(337) 439-3380
Mailing address
4924 S PRIEN LAKE RD, LAKE CHARLES, LA 70605
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
210697
LA
Other
Enumeration date
08/25/2006
Last updated
07/08/2007
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