MEDICARE: LILA O'MALLEY OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	027714	NY

General Provider Information

NPI Number	:	1649884701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILA O'MALLEY OTR

Provider Business Mailing Address
First Line	:	103 TAFT DR
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-2725
Country	:	US
Telephone Number	:	910-431-5331
Fax Number	:

Provider Business Practice Location Address
First Line	:	3391 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-2025
Country	:	US
Telephone Number	:	718-608-9170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	12/09/2025

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Directions to “ LILA O'MALLEY OTR” Practice Location

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