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General NPI Number Information
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NPI Number | 1497339766
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Entity Type | Individual
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Provider Name | MALLORY VARNUM OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 2625 E SAINT LOUIS AVE
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City | LAS VEGAS
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State | NV
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Zip | 89104-4200
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Country | US
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Telephone | 303-563-8290
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Fax |
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Provider Business Mailing Address
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Address Line | 211 VIA DEL AQUA
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City | CLEWISTON
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State | FL
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Zip | 33440-2420
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Country | US
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Telephone | 863-233-3846
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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