Provider Demographics
NPI:1588670640
Name:MALONE, SHEILA MARY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:MARY
Last Name:MALONE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:SHEILA
Other - Middle Name:MARY
Other - Last Name:ZURAWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:42615 GARFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-412-2846
Mailing Address - Fax:586-412-7087
Practice Address - Street 1:29600 WIXOM RD
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3430
Practice Address - Country:US
Practice Address - Phone:248-960-1600
Practice Address - Fax:248-960-9755
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N45090OtherMEDICARE GRP PTAN
MIN45090019Medicare PIN