Healthcare Provider Details

I. General information

NPI: 1487319349
Provider Name (Legal Business Name): MALLORY HUG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 S RIO GRANDE AVE STE 206
ORLANDO FL
32809-4650
US

IV. Provider business mailing address

6126 CHES CT
ORLANDO FL
32819-4315
US

V. Phone/Fax

Practice location:
  • Phone: 407-280-3776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT22367
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: