Provider Demographics
NPI:1013288141
Name:MCALASTER, JUSTIN BRUCE (OT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BRUCE
Last Name:MCALASTER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 POPLAR AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-7506
Mailing Address - Country:US
Mailing Address - Phone:901-728-6912
Mailing Address - Fax:901-701-2428
Practice Address - Street 1:4515 POPLAR AVE STE 210
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7506
Practice Address - Country:US
Practice Address - Phone:901-728-6912
Practice Address - Fax:901-701-2428
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1279225X00000X
TN3789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist