Provider Demographics
NPI:1538512645
Name:STOKES, MALLORY (OTR/L)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:STOKES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-4617
Mailing Address - Country:US
Mailing Address - Phone:601-927-3795
Mailing Address - Fax:888-408-8272
Practice Address - Street 1:213 ALLEN DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-4617
Practice Address - Country:US
Practice Address - Phone:601-927-3795
Practice Address - Fax:888-408-8272
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3235225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist