Provider Demographics
NPI:1891235016
Name:MCCLEARY, MARY JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JO
Other - Last Name:REISTROFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10910 NE 75TH ST
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-1146
Mailing Address - Country:US
Mailing Address - Phone:515-643-9823
Mailing Address - Fax:515-643-9838
Practice Address - Street 1:501 SW 7TH ST
Practice Address - Street 2:SUITE Q
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4536
Practice Address - Country:US
Practice Address - Phone:515-643-9800
Practice Address - Fax:515-643-9838
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist