MEDICARE: MRS. BOBBI MALLOL ORT/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
1	225X00000X	Occupational Therapist	2993	NC

General Provider Information

NPI Number	:	1104298330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BOBBI MALLOL ORT/L

Provider Business Mailing Address
First Line	:	4011 LITTLE JOHN DR N
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27896-8949
Country	:	US
Telephone Number	:	252-315-1337
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 TARBORO ST NE
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-4016
Country	:	US
Telephone Number	:	252-399-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2015
Last Update Date	:	03/10/2026

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