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General NPI Number Information
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NPI Number | 1841075801
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Entity Type | Individual
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Provider Name | ALY JEAN LEBLANC-MALLOY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 700 BIRCH LN
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City | WAYNESVILLE
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State | MO
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Zip | 65583-2275
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Country | US
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Telephone | 573-774-6456
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Fax |
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Provider Business Mailing Address
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Address Line | 16 SIERRA LN
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City | MADISON
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State | ME
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Zip | 04950-3928
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Country | US
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Telephone | 207-399-7648
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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 | OT4351
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License Number State | ME
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