MEDICARE: MS. MARIA MELISSA LEONIDA MALILAY 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
1	225X00000X	Occupational Therapist	016011-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	016011-1	OTHER	NY	NY LICENSE

General Provider Information

NPI Number	:	1538476940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA MELISSA LEONIDA MALILAY OTR

Provider Business Mailing Address
First Line	:	3310 QUEENS BLVD STE 301
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2302
Country	:	US
Telephone Number	:	718-593-4121
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 QUEENS BLVD STE 301
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2302
Country	:	US
Telephone Number	:	718-593-4121
Fax Number	:

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

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	09/07/2010

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