Provider Demographics
NPI:1124576384
Name:MCINTOSH, MALLORY ANN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MALLORY
Middle Name:ANN
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9618
Mailing Address - Country:US
Mailing Address - Phone:716-625-4002
Mailing Address - Fax:
Practice Address - Street 1:5205 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9618
Practice Address - Country:US
Practice Address - Phone:716-625-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020705225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics