Healthcare Provider Details

I. General information

NPI: 1871807297
Provider Name (Legal Business Name): MARILYN ADAIR CORRIGAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILYN ADAIR MCDOWELL

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 RACETRACK RD NW
FT WALTON BCH FL
32547-1640
US

IV. Provider business mailing address

26 RACETRACK RD NW STE E
FORT WALTON BEACH FL
32547-1640
US

V. Phone/Fax

Practice location:
  • Phone: 850-374-3465
  • Fax:
Mailing address:
  • Phone: 248-644-3920
  • Fax: 855-978-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201001476
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT22394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: