Provider Demographics
NPI:1730483363
Name:MALLOY, RACHEL (OTR)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MALLOY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 W END AVE
Mailing Address - Street 2:APT R19D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7853
Mailing Address - Country:US
Mailing Address - Phone:646-272-8445
Mailing Address - Fax:
Practice Address - Street 1:75 W END AVE
Practice Address - Street 2:APT R19D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7853
Practice Address - Country:US
Practice Address - Phone:646-272-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010096225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics