Provider Demographics
NPI:1548097439
Name:MASSEY, MALLORY R (OTR/L)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:R
Last Name:MASSEY
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 1:4745 SUTTON PARK CT STE 403
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0255
Mailing Address - Country:US
Mailing Address - Phone:904-371-4649
Mailing Address - Fax:888-393-1099
Practice Address - Street 1:4745 SUTTON PARK CT STE 403
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0255
Practice Address - Country:US
Practice Address - Phone:904-371-4649
Practice Address - Fax:888-393-1099
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25609225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation