Provider Demographics
NPI:1164848784
Name:MAHONY, MELISSA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MAHONY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:PINGLORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:49 OLD DUTCH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4539
Mailing Address - Country:US
Mailing Address - Phone:845-786-4000
Mailing Address - Fax:845-786-4068
Practice Address - Street 1:51-55 RT 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993
Practice Address - Country:US
Practice Address - Phone:845-786-4000
Practice Address - Fax:845-786-4068
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017135-1225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation