Provider Demographics
NPI:1790453892
Name:MOYNIHAN, MADALYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MADALYN
Middle Name:
Last Name:MOYNIHAN
Suffix:
Gender:F
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 1:2 WINDY HILL
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-9737
Mailing Address - Country:US
Mailing Address - Phone:717-917-0175
Mailing Address - Fax:
Practice Address - Street 1:1200 GRUBB RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-3514
Practice Address - Country:US
Practice Address - Phone:717-838-5406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant