Provider Demographics
NPI:1477981009
Name:MCDONAL, MABLE ANNETTE
Entity type:Individual
Prefix:
First Name:MABLE
Middle Name:ANNETTE
Last Name:MCDONAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MABLE
Other - Middle Name:ANNETTE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:673 BAYWOOD POINTE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9573
Mailing Address - Country:US
Mailing Address - Phone:769-257-1724
Mailing Address - Fax:
Practice Address - Street 1:673 BAYWOOD POINTE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9573
Practice Address - Country:US
Practice Address - Phone:769-257-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0383225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics