Provider Demographics
NPI:1942629886
Name:FALLON, MARY CATHERINE (COTA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:FALLON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
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Mailing Address - Street 1:2502 S NC HIGHWAY 119
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9565
Mailing Address - Country:US
Mailing Address - Phone:336-578-5815
Mailing Address - Fax:336-578-7269
Practice Address - Street 1:2502 S NC HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9565
Practice Address - Country:US
Practice Address - Phone:336-578-5815
Practice Address - Fax:336-578-7269
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0550224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant