Individual provider Active NPI

Mallory Denise Santerre, OTR/L

  • Occupational Therapist
  • Severna Park, MD
National Provider Identifier
1700245685
Registry record updated Feb 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
07797 Issued in MD
Practice address
645 Baltimore Annapolis Blvd
Ste 111
Severna Park, MD 21146-3931
Phone
(410) 544-2500
Fax
(410) 384-9703
NPI assigned
Feb 19, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 07797 MD Primary

Addresses

Primary practice location

645 Baltimore Annapolis Blvd
Ste 111
Severna Park, MD 21146-3931

Mailing address

645 Baltimore Annapolis Blvd
Ste 111
Severna Park, MD 21146-3931
Phone (410) 544-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160317000679 MD Practitioner - Occupational Therapist in Private Practice 0143526103 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
07797MDMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Cypress Creek Therapy Associates LLC Occupational Therapist CurrentSince Mar 3, 2016 Accepting new patients

Locations

20 Mayo Rd
Ste 205
Edgewater, MD 21037
Phone (410) 384-9242

645 Baltimore Annapolis Blvd
Ste 111
Severna Park, MD 21146
Phone (410) 544-2500

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455840000000",
    "number": "1700245685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 BALTIMORE ANNAPOLIS BLVD",
            "address_2": "STE 111",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211463931",
            "telephone_number": "410-544-2500",
            "fax_number": "410-384-9703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 BALTIMORE ANNAPOLIS BLVD",
            "address_2": "STE 111",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211463931",
            "telephone_number": "410-544-2500",
            "fax_number": "410-384-9703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTERRE",
        "first_name": "MALLORY",
        "middle_name": "DENISE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-19",
        "last_updated": "2016-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "07797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Severna Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.