Healthcare Provider Details

I. General information

NPI: 1386074813
Provider Name (Legal Business Name): DAYNA MALCHOW OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E BYWAY
GREENWICH CT
06831-3618
US

IV. Provider business mailing address

15 E BYWAY
GREENWICH CT
06831-3618
US

V. Phone/Fax

Practice location:
  • Phone: 203-918-2688
  • Fax:
Mailing address:
  • Phone: 203-918-2688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003296
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number012759-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: