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General NPI Number Information
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NPI Number | 1407764160
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Entity Type | Individual
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Provider Name | MALLORY DEMING
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Gender | Female
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 9301 N 76TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53223-1074
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Country | US
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Telephone | 414-355-9300
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Fax |
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Provider Business Mailing Address
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Address Line | N143W6487 LAYTON ST APT 2
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City | CEDARBURG
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State | WI
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Zip | 53012-3010
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Country | US
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Telephone | 217-242-9622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 7358
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License Number State | WI
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