Most Relevant Information
Provider Data
| NPI Number: | 1003424748 |
| Provider Name: | MALLORY V PEDEN MOT |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | PT3794 |
Most Important Dates
| Enumeration Date: | 07/20/2020 |
| Last Updated: | 08/30/2023 |
Provider Practice Location
960 COMMONWEALTH BLVD
TUPELO
MS
388049762
Practice Location Phone/Fax
| Phone: | 6622603789 |
| Fax: | 6622603790 |
Provider Mailing Location
8205 PRESIDENTS DR
HUMMELSTOWN
PA
170368621
Provider Mailing Phone/Fax
| Phone: | 7178392188 |
| Fax: | 7175651104 |