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General NPI Number Information
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NPI Number | 1629422803
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Entity Type | Individual
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Provider Name | MALORY TURNAGE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 310 W PLAZA DR
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City | CARTERVILLE
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State | IL
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Zip | 62918-1980
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Country | US
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Telephone | 855-608-3560
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Fax | 618-985-1020
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Provider Business Mailing Address
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Address Line | 11902 KHOURY LEAGUE RD
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City | MARION
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State | IL
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Zip | 62959-6369
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Country | US
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Telephone | 618-218-1652
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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 | 057.004338
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License Number State | IL
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