Provider Demographics
NPI:1871158477
Name:MCCARTHY FLEMING, MALLORY (COTA/L)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:MCCARTHY FLEMING
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 S HOLLY CIR STE 290
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1076
Mailing Address - Country:US
Mailing Address - Phone:720-542-8737
Mailing Address - Fax:
Practice Address - Street 1:6851 S HOLLY CIR.
Practice Address - Street 2:STE 290
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1016
Practice Address - Country:US
Practice Address - Phone:720-542-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0661224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant