MEDICARE: MALLORY LEE PRITCHARD M.S., OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	3534	AL

General Provider Information

NPI Number	:	1811236805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY LEE PRITCHARD M.S., OTR/L

Provider Business Mailing Address
First Line	:	1308 INGRAM AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1504
Country	:	US
Telephone Number	:	334-590-9669
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 CAHABA HEIGHTS RD
Second Line	:	SUITE 102
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5243
Country	:	US
Telephone Number	:	205-969-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2013
Last Update Date	:	04/17/2014

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