Provider Demographics
NPI:1861722811
Name:MULLEN, ILSE JO-ANNETTE
Entity type:Individual
Prefix:MRS
First Name:ILSE
Middle Name:JO-ANNETTE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ILSE
Other - Middle Name:JO-ANNETTE
Other - Last Name:SCRIVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7928 VIREO CT SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5502
Mailing Address - Country:US
Mailing Address - Phone:360-528-9376
Mailing Address - Fax:
Practice Address - Street 1:7928 VIREO CT SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-5502
Practice Address - Country:US
Practice Address - Phone:360-528-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist