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General NPI Number Information
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NPI Number | 1598397283
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Entity Type | Individual
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Provider Name | MALLORY BOOZER
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Gender | Female
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 2713 BREEZEWOOD AVE # 5535
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5534
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Country | US
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Telephone | 910-488-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 3230 GLENMORE DR
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City | HOPE MILLS
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State | NC
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Zip | 28348-1701
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Country | US
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Telephone | 615-482-2530
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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 | 12958
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License Number State | NC
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