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General NPI Number Information
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NPI Number | 1144493750
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Entity Type | Individual
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Provider Name | JESSICA FAYE MALOY ATC
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Gender | Female
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 10/18/2015
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Provider Practice Location Address
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Address Line | 80 VANDENBURGH AVE
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City | TROY
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State | NY
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Zip | 12180-6037
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Country | US
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Telephone | 845-863-9617
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Fax |
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Provider Business Mailing Address
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Address Line | 20 CHERRY LN
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City | GHENT
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State | NY
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Zip | 12075-1201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001534-1
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License Number State | NY
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