Provider Demographics
NPI:1114441185
Name:MALLONEE, AMBER (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MALLONEE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4826
Mailing Address - Country:US
Mailing Address - Phone:610-506-4997
Mailing Address - Fax:
Practice Address - Street 1:1777 SENTRY PKWY W STE 203
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2227
Practice Address - Country:US
Practice Address - Phone:610-227-1100
Practice Address - Fax:215-646-1900
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009054225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist