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NPI Code Detail

MEDICARE: KAREN HELEN MALLEY C.O.T.A./L

MEDICARE: KAREN HELEN MALLEY C.O.T.A./L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant0238AZ

General Provider Information

NPI Number : 1073709630
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN HELEN MALLEY C.O.T.A./L
Provider Business Mailing Address
First Line : 2240 E ANGELA DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85022-2216
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16428 E KINGSTREE BLVD
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85268-5440
Country : US
Telephone Number : 480-837-4565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2007
Last Update Date : 03/31/2008

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