Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OTT.Z10271 | LA |
NPI | 1073727905 |
---|---|
Provider Name | Mrs. Mary Jennette Mccloy |
First Address | Mandeville, LA 70448-6608 |
Second Address | Mandeville, LA 70448-6608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |