Provider Demographics
NPI:1871250308
Name:MACLEOD, MATLYN ALEXIS (OTR/L)
Entity Type:Individual
Prefix:
First Name:MATLYN
Middle Name:ALEXIS
Last Name:MACLEOD
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 1:408 WESTMORE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-3234
Mailing Address - Country:US
Mailing Address - Phone:812-449-0789
Mailing Address - Fax:
Practice Address - Street 1:408 WESTMORE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-3234
Practice Address - Country:US
Practice Address - Phone:812-449-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY464194208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation