Provider Demographics
NPI:1750156618
Name:MASSENGILL, MALLORY ANNETTE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:ANNETTE
Last Name:MASSENGILL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 HELMSHURST LN SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-9156
Mailing Address - Country:US
Mailing Address - Phone:423-903-0640
Mailing Address - Fax:
Practice Address - Street 1:294 HELMSHURST LN SE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-9156
Practice Address - Country:US
Practice Address - Phone:423-903-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4427225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist