Organization
PEDEN PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MALLORY VANCE PEDEN OTR/L (OWNER)
(601) 480-8741
Entity
Organization
Contact information
Practice address
2363 TUTOR RD, ECRU, MS 38841-9106
(601) 480-8741
Mailing address
PO BOX 236, ECRU, MS 38841-0236
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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