Provider Demographics
NPI:1386077071
Name:MCNAUGHTON, MARY (OTR)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCNAUGHTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 BELLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-3226
Mailing Address - Country:US
Mailing Address - Phone:810-343-4508
Mailing Address - Fax:
Practice Address - Street 1:3041 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3877
Practice Address - Country:US
Practice Address - Phone:810-343-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003509225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist