Provider Demographics
NPI:1720532914
Name:MCCLURE, MARY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 MURPHYS LANDING DR APT 202
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-3374
Mailing Address - Country:US
Mailing Address - Phone:402-990-4504
Mailing Address - Fax:
Practice Address - Street 1:6239 S EAST ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2088
Practice Address - Country:US
Practice Address - Phone:317-791-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006145A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist