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Individual

MS. MARTHA MULVIHILL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTRL

Contact information

Practice address
2690 BOLDT ST, LAS CRUCES, NM 88005-3874
(505) 647-0974
Mailing address
2690 BOLDT ST, LAS CRUCES, NM 88005-3874
(505) 647-0974

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
503
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000T6389
NM
01
503
NM OT LICENSE
NM
Enumeration date
04/25/2007
Last updated
07/09/2007
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