Provider Demographics
NPI:1558701359
Name:ASHE, MALLORY L (MOTR/L)
Entity Type:Individual
Prefix:MISS
First Name:MALLORY
Middle Name:L
Last Name:ASHE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:LYNN
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MALLORY LYNN PARKS
Mailing Address - Street 1:3 COUNTY ROAD 617A
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-1186
Mailing Address - Country:US
Mailing Address - Phone:901-412-6441
Mailing Address - Fax:
Practice Address - Street 1:950 E COUNTY LINE RD STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1928
Practice Address - Country:US
Practice Address - Phone:601-308-5117
Practice Address - Fax:601-308-5103
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2627225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist