Individual
MALLORY A VIRGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
7300 E INDIANA ST, SUITE 102, EVANSVILLE, IN 47715-2794
(812) 759-7457
(812) 759-7487
Mailing address
7300 E INDIANA ST, SUITE 102, EVANSVILLE, IN 47715-2794
(812) 476-0409
(812) 476-1016
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001704A
IN
Other
Enumeration date
10/30/2009
Last updated
08/31/2012
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