Individual
MR. MATTHEW MALLMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MOTR/L
Contact information
Practice address
3655 S BALDWIN RD, LAKE ORION, MI 48359-1506
(248) 393-1699
(248) 393-1711
Mailing address
3655 S BALDWIN RD, LAKE ORION, MI 48359-1506
(248) 393-1699
(248) 393-1711
Taxonomy
Speciality
Code
Description
License number
State
225XE0001X
Environmental Modification Occupational Therapist
L2411741
MI
225XE1200X
Ergonomics Occupational Therapist
L2411741
MI
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
L2411741
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45-4940205
TAX ID
MI
Enumeration date
03/01/2013
Last updated
08/21/2015
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