Provider Demographics
NPI:1619699659
Name:WARRICK, MALLORY ROY (OTD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:ROY
Last Name:WARRICK
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:DR
Other - First Name:MALLORY
Other - Middle Name:ANNE
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:151B RUTLEDGE AVE # MSC962
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-9620
Mailing Address - Country:US
Mailing Address - Phone:843-792-0701
Mailing Address - Fax:
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:918-688-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist