Healthcare Provider Details

I. General information

NPI: 1689043945
Provider Name (Legal Business Name): JUSTINE SUZANNA HUTCHINS MCALLISTER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PROSPECT ST
CLARK MILLS NY
13321-3339
US

IV. Provider business mailing address

PO BOX 466
CLARK MILLS NY
13321-0466
US

V. Phone/Fax

Practice location:
  • Phone: 315-794-1285
  • Fax:
Mailing address:
  • Phone: 315-794-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number63020030
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: