Provider Demographics
NPI:1306484480
Name:PILCHER, MALLORY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:PILCHER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 E 100 S APT 122
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1845
Mailing Address - Country:US
Mailing Address - Phone:970-314-5456
Mailing Address - Fax:
Practice Address - Street 1:447 E 100 S APT 122
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1845
Practice Address - Country:US
Practice Address - Phone:970-314-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist