Individual
MALLORY CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L, B.I.S.
Contact information
Practice address
12550 W PALM LN, AVONDALE, AZ 85392-6594
(623) 824-2147
Mailing address
12550 W PALM LN, AVONDALE, AZ 85392-6594
(623) 824-2147
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5379
AZ
Other
Enumeration date
03/18/2015
Last updated
03/18/2015
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