Provider Demographics
NPI:1891130373
Name:COMPTON, MALLORY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:COMPTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 S WEBB RD APT 916
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-4138
Mailing Address - Country:US
Mailing Address - Phone:316-990-6794
Mailing Address - Fax:
Practice Address - Street 1:1157 S WEBB RD APT 916
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-4138
Practice Address - Country:US
Practice Address - Phone:316-990-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00882224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant