Active NPI
Aly Jean Leblanc-Malloy, OTR/L
- Occupational Therapist
- Waynesville, MO
National Provider Identifier
1841075801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT4351
- Practice address
- 700 Birch LN
Waynesville, MO 65583-2275 - Phone
- (573) 774-6456
- NPI assigned
- Aug 29, 2023
- Last updated
- Jun 4, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT4351 | ME | Primary |
Addresses
Primary practice location
700 Birch LN
Waynesville, MO 65583-2275
Mailing address
16 Sierra LN
Madison, ME 04950-3928
Phone (207) 399-7648
Other practice location 1
227 Poland Rd
Auburn, ME 04210-4263
Phone (207) 344-6226
Other practice location 2
744 Oakland Rd
Belgrade, ME 04917-3411
Phone (207) 465-7985
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT4351 | ME | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Becket Academy, Inc. | Multi-Specialty | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717459200000",
"number": "1841075801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 SIERRA LN",
"city": "MADISON",
"state": "ME",
"postal_code": "049503928",
"telephone_number": "207-399-7648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 BIRCH LN",
"city": "WAYNESVILLE",
"state": "MO",
"postal_code": "655832275",
"telephone_number": "573-774-6456"
}
],
"practiceLocations": [
{
"address_1": "227 Poland Rd",
"address_purpose": "LOCATION",
"city": "Auburn",
"state": "ME",
"postal_code": "042104263",
"country_code": "US",
"telephone_number": "207-344-6226",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "744 Oakland Rd",
"address_purpose": "LOCATION",
"city": "Belgrade",
"state": "ME",
"postal_code": "049173411",
"country_code": "US",
"telephone_number": "207-465-7985",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEBLANC-MALLOY",
"first_name": "ALY",
"middle_name": "JEAN",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-29",
"last_updated": "2024-06-04",
"certification_date": "2024-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "ME",
"license": "OT4351",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waynesville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.