Healthcare Provider Details

I. General information

NPI: 1407465974
Provider Name (Legal Business Name): MALLORIE LINN SCHNELLBACHER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 NE 7TH ST
TRENTON FL
32693-3636
US

IV. Provider business mailing address

303 NW16TH AVE
GAINESVILLE FL
32601
US

V. Phone/Fax

Practice location:
  • Phone: 352-463-7101
  • Fax:
Mailing address:
  • Phone: 352-978-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: