Provider Demographics
NPI:1033170048
Name:MALLOY, ELLEN ANN (ATC)
Entity Type:Individual
Prefix:MISS
First Name:ELLEN
Middle Name:ANN
Last Name:MALLOY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 JERUSALEM RD
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1412
Mailing Address - Country:US
Mailing Address - Phone:781-383-0686
Mailing Address - Fax:
Practice Address - Street 1:745 WASHINGTON ST
Practice Address - Street 2:THAYER ACADEMY
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5751
Practice Address - Country:US
Practice Address - Phone:781-664-2273
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH 952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer