Healthcare Provider Details

I. General information

NPI: 1811307200
Provider Name (Legal Business Name): MALORIE VUONG MS, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7935 E PRENTICE AVE #104
GREENWOOD VILLAGE CO
80111-2708
US

IV. Provider business mailing address

7935 E PRENTICE AVE #104
GREENWOOD VILLAGE CO
80111-2708
US

V. Phone/Fax

Practice location:
  • Phone: 303-756-0280
  • Fax:
Mailing address:
  • Phone: 303-756-0280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0003972
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0003972
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: