Provider Demographics
NPI:1831869734
Name:PULFER, MALLORY (COTA)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:PULFER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:WALKER-PULFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:183 HARMON SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:TN
Mailing Address - Zip Code:38573-6112
Mailing Address - Country:US
Mailing Address - Phone:931-871-9302
Mailing Address - Fax:
Practice Address - Street 1:183 HARMON SMITH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:TN
Practice Address - Zip Code:38573-6112
Practice Address - Country:US
Practice Address - Phone:931-871-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18574224Z00000X
TN3950224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant