Provider Demographics
NPI:1407465974
Name:SCHNELLBACHER, MALLORIE LINN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MALLORIE
Middle Name:LINN
Last Name:SCHNELLBACHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 NW16TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601
Mailing Address - Country:US
Mailing Address - Phone:352-978-2240
Mailing Address - Fax:
Practice Address - Street 1:606 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3636
Practice Address - Country:US
Practice Address - Phone:352-463-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21112225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist