Individual
MALLORY MANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
8624 W SWEETWATER AVE, PEORIA, AZ 85381-8101
(623) 412-4850
Mailing address
4600 E SHEA BLVD STE 101, PHOENIX, AZ 85028-6031
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.004152
OH
Other
Enumeration date
07/24/2012
Last updated
03/19/2021
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