Provider Demographics
NPI:1497121057
Name:MACKRELL, CALLY MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:CALLY
Middle Name:MARIE
Last Name:MACKRELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8512 HILL ST
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4615
Mailing Address - Country:US
Mailing Address - Phone:443-878-9279
Mailing Address - Fax:
Practice Address - Street 1:8512 HILL ST
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4615
Practice Address - Country:US
Practice Address - Phone:443-878-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-27062255A2300X
MDA00012402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer