Healthcare Provider Details

I. General information

NPI: 1114441185
Provider Name (Legal Business Name): AMBER MALLONEE MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 SENTRY PKWY W STE 203
BLUE BELL PA
19422-2227
US

IV. Provider business mailing address

4370 FLEMING ST
PHILADELPHIA PA
19128-4826
US

V. Phone/Fax

Practice location:
  • Phone: 610-227-1100
  • Fax: 215-646-1900
Mailing address:
  • Phone: 610-506-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC009054
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: