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NPI Code Detail

MEDICARE: MS. SHOMBAI L MALONE OTR

MEDICARE: MS. SHOMBAI L MALONE OTR
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
1225X00000XOccupational Therapist46TR00387600NJ
2225X00000XOccupational Therapist9487NC

General Provider Information

NPI Number : 1518199017
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHOMBAI L MALONE OTR
Provider Business Mailing Address
First Line : 12040 BROWNESTONE VIEW DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-7198
Country : US
Telephone Number : 908-294-3732
Fax Number :
Provider Business Practice Location Address
First Line : 877 HILL EVERHART RD
Second Line :
City : LEXINGTON
State : NC
Zip : 27295-9140
Country : US
Telephone Number : 336-248-6644
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2009
Last Update Date : 07/15/2024

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