Provider Demographics
NPI:1730721317
Name:WARE, MAHLON (OTR)
Entity type:Individual
Prefix:
First Name:MAHLON
Middle Name:
Last Name:WARE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SETTLERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3665
Mailing Address - Country:US
Mailing Address - Phone:972-230-1494
Mailing Address - Fax:
Practice Address - Street 1:1707 FOUNTAINVIEW DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5091
Practice Address - Country:US
Practice Address - Phone:817-752-9662
Practice Address - Fax:682-400-8251
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122142225X00000X, 225XP0200X
TX213733224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant