Provider Demographics
NPI:1578111019
Name:MALLOY, DANIEL P (COTA/L)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:MALLOY
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 IMPERIAL PARK
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1019
Mailing Address - Country:US
Mailing Address - Phone:845-544-4756
Mailing Address - Fax:
Practice Address - Street 1:726 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2654
Practice Address - Country:US
Practice Address - Phone:845-394-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant