Provider Demographics
NPI:1144330796
Name:MULLINS, VICKIE PATRICIA (OTR / CHT)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:PATRICIA
Last Name:MULLINS
Suffix:
Gender:F
Credentials:OTR / CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4038
Mailing Address - Country:US
Mailing Address - Phone:920-683-1900
Mailing Address - Fax:
Practice Address - Street 1:920 STATE ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4038
Practice Address - Country:US
Practice Address - Phone:920-683-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1051100444225XE1200X
WI266-026225XH1200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40855800Medicaid
WI40855800Medicaid