Healthcare Provider Details

I. General information

NPI: 1720229420
Provider Name (Legal Business Name): MARIAH SUZANNE MCLEAD MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 FAIRWOOD AVE
CLEARWATER FL
33759-3134
US

IV. Provider business mailing address

7807 BAYMEADOWS RD E
JACKSONVILLE FL
32256-9664
US

V. Phone/Fax

Practice location:
  • Phone: 727-543-4207
  • Fax:
Mailing address:
  • Phone: 877-990-0091
  • Fax: 904-398-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT13432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: