Provider Demographics
NPI:1609003599
Name:O'MALLEY, EDWARD JOSEPH (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-1402
Mailing Address - Country:US
Mailing Address - Phone:845-292-6307
Mailing Address - Fax:845-292-6307
Practice Address - Street 1:333 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1402
Practice Address - Country:US
Practice Address - Phone:845-292-6307
Practice Address - Fax:845-292-6307
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006150-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3887OtherDEPARTMENT OF HEALTH - NYS EARLY INTERVENTION PROGRAM
NY006150-1OtherNYS DEPT OF EDUCATION, OFFICE OF THE PROFESSIONS