Provider Demographics
NPI:1174343925
Name:MACLELLAN, MALLORY NOEL (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:NOEL
Last Name:MACLELLAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 FAIRMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1325
Mailing Address - Country:US
Mailing Address - Phone:443-974-1811
Mailing Address - Fax:
Practice Address - Street 1:4640 WEDGEWOOD BLVD STE 101-105
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7114
Practice Address - Country:US
Practice Address - Phone:240-457-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10386225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist