Provider Demographics
NPI:1700577582
Name:BROUGHTON, MCKALYNNE MARSH (OTR/L, OTD)
Entity type:Individual
Prefix:
First Name:MCKALYNNE
Middle Name:MARSH
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E BUTLER RD STE D
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-3251
Mailing Address - Country:US
Mailing Address - Phone:864-334-7809
Mailing Address - Fax:
Practice Address - Street 1:306 E BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-3251
Practice Address - Country:US
Practice Address - Phone:864-372-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist