Provider Demographics
NPI:1124845698
Name:GEOGHEGAN, MALLORY A (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MALLORY
Middle Name:A
Last Name:GEOGHEGAN
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 1:400 N ERIE HWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4263
Mailing Address - Country:US
Mailing Address - Phone:513-887-3710
Mailing Address - Fax:
Practice Address - Street 1:2171 BRIDGEPORT DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-5193
Practice Address - Country:US
Practice Address - Phone:513-868-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT013042225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist