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NPI Code Detail

MEDICARE: MALLORY RAE LOEFFLER

MEDICARE: MALLORY RAE LOEFFLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1114492253
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY RAE LOEFFLER
Provider Business Mailing Address
First Line : 212 W 10TH ST APT 10
Second Line :
City : CHARLOTTE
State : NC
Zip : 28202-1782
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1401 E 7TH ST STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-6301
Country : US
Telephone Number : 704-461-3037
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2018
Last Update Date : 10/04/2018

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Directions to “ MALLORY RAE LOEFFLER ” Practice Location

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