Healthcare Provider Details

I. General information

NPI: 1255431730
Provider Name (Legal Business Name): MARK ALAN RUTLEDGE OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24349 KATIE LN
WATERTOWN NY
13601-5137
US

IV. Provider business mailing address

24349 KATIE LN
WATERTOWN NY
13601-5137
US

V. Phone/Fax

Practice location:
  • Phone: 315-767-4931
  • Fax:
Mailing address:
  • Phone: 315-767-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008883-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number008883-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number008883-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number008883-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: