Healthcare Provider Details

I. General information

NPI: 1508905415
Provider Name (Legal Business Name): LINDA ARLENE MALLOY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 13TH ST W
BILLINGS MT
59102-1705
US

IV. Provider business mailing address

2317 ASH ST
BILLINGS MT
59101-0506
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-3800
  • Fax: 406-245-1149
Mailing address:
  • Phone: 406-256-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number50
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: