Provider Demographics
NPI:1720229420
Name:MCLEAD, MARIAH SUZANNE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:SUZANNE
Last Name:MCLEAD
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 BAYMEADOWS RD E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9664
Mailing Address - Country:US
Mailing Address - Phone:877-990-0091
Mailing Address - Fax:904-398-4148
Practice Address - Street 1:401 FAIRWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3134
Practice Address - Country:US
Practice Address - Phone:727-543-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist