Mallory Childress COTA/L, B.I.S.

NPI 1053705806 - Occupational Therapy Assistant - 224Z00000X

NPI Details
NPI 1053705806
Gender Female
Enumeration Date 03/18/2015
Last Updated 03/18/2015
Entity Type Individual
Active Over 1 year ago
Practice Location
12550 W PALM LN
AVONDALE AZ, 85392-6594, US
Phone (623) 824-2147
Fax
Business Location
12550 W PALM LN
AVONDALE AZ, 85392-6594, US
Phone (623) 824-2147
Fax
Toxanomy
Taxonomy Code 224Z00000X
License State Arizona
License Number 5379
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According to our database, Mallory Childress COTA/L, B.I.S. NPI is 1053705806, taxonomy code is 224Z00000X and license number is 5379, license state is located at Arizona. Mallory Childress COTA/L, B.I.S. physically located at 12550 W Palm Ln, Avondale AZ, 85392-6594. NPI Number Mallory Childress COTA/L, B.I.S. has the Individual type.

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1053705806 NPI number is provided on an as is basis without warranty of any kind. 1053705806 is maintained by the National Plan & Provider Enumeration System. The contents of Mallory Childress COTA/L, B.I.S. are for informational purposes only.